Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year - Roemer, Frank; Kwoh, C. Kent; Hannon, Michael J.; Hunter, David J.; Eckstein, Felix; Grago, Jason; Boudreau, Robert M.; Englund, Martin; Guermazi, Ali (European Radiology, 2017)
To assess whether partial meniscectomy is associated with increased risk of radiographic osteoarthritis (ROA) and worsening cartilage damage in the following year.We studied 355 knees from the Osteoarthritis Initiative that developed ROA (Kellgren-Lawrence grade >= 2), which were matched with control knees. The MR images were assessed using the semi-quantitative MOAKS system. Conditional logistic regression was applied to estimate risk of incident ROA. Logistic regression was used to assess the risk of worsening cartilage damage in knees with partial meniscectomy that developed ROA.In the group with incident ROA, 4.4 % underwent partial meniscectomy during the year prior to the case-defining visit, compared with none of the knees that did not develop ROA. All (n = 31) knees that had partial meniscectomy and 58.9 % (n = 165) of the knees with prevalent meniscal damage developed ROA (OR = 2.51, 95 % CI [1.73, 3.64]). In knees that developed ROA, partial meniscectomy was associated with an increased risk of worsening cartilage damage (OR = 4.51, 95 % CI [1.53, 13.33]).The probability of having had partial meniscectomy was higher in knees that developed ROA. When looking only at knees that developed ROA, partial meniscectomy was associated with greater risk of worsening cartilage damage.o Partial meniscectomy is a controversial treatment option for degenerative meniscal tears. o Partial meniscectomy is strongly associated with incident osteoarthritis within 1 year. o Partial meniscectomy is associated with increased risk of worsening cartilage damage.
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PASSED: Brain atrophy in non-demented individuals in a long-term longitudinal study from two independent cohorts - Haas, Anna-Lena; Olm, Pauline; Utz, Janine; Siegmann, Eva-Maria; Spitzer, Philipp; Florvaag, Anna; Schmidt, Manuel; Dörfler, Arnd; Lewczuk, Piotr; Kornhuber, Johannes; Maler, Juan Manuel; Oberstein, Timo (Frontiers in Aging Neuroscience, 2023)
Introduction: Alzheimer’s disease (AD) is indicated by a decrease in amyloid beta 42 (Aβ42) level or the Aβ42/Aβ40 ratio, and by increased levels of Tau with phosphorylated threonine at position 181 (pTau181) in cerebrospinal fluid (CSF) years before the onset of clinical symptoms. However, once only pTau181 is increased, cognitive decline in individuals with subjective or mild cognitive impairment is slowed compared to individuals with AD. Instead of a decrease in Aβ42 levels, an increase in Aβ42 was observed in these individuals, leading to the proposal to refer to them as nondemented subjects with increased pTau-levels and Aβ surge with subtle cognitive deterioration (PASSED). In this study, we determined the longitudinal atrophy rates of AD, PASSED, and Biomarker-negative nondemented individuals of two independent cohorts to determine whether these groups can be distinguished by their longitudinal atrophy patterns or rates. Methods: Depending on their CSF-levels of pTau 181 (T), total Tau (tTau, N), Aβ42 or ratio of Aβ42/Aβ40 (A), 185 non-demented subjects from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and 62 non-demented subjects from Erlangen AD cohort were assigned to an ATN group (A–T–N–, A–T+N±, A+T–N±and A+T+N±) and underwent T1-weighted structural magnetic resonance imaging (sMRI). Longitudinal grey matter (GM) atrophy patterns were assessed with voxel-based morphometry (VBM) using the cat12 toolbox on spm12 (statistical parametric mapping) of MRI scans from individuals in the ADNI cohort with a mean follow-up of 2 and 5 years, respectively. The annualized atrophy rate for individuals in the Erlangen cohort was determined using region of interest analysis (ROI) in terms of a confirmatory analysis. Results: In the A–T+N± group, VBM did not identify any brain region that showed greater longitudinal atrophy than the A+T+N±, A+T+N± or biomarker negative control group. In contrast, marked longitudinal atrophy in the temporal lobe was evident in the A+T–N± group compared with A+T–N± and biomarker-negative subjects. The ROI in the angular gyrus identified by VBM analysis of the ADNI cohort did not discriminate better than the hippocampal volume and atrophy rate between AD and PASSED in the confirmatory analysis. Discussion: In this study, nondemented subjects with PASSED did not show a unique longitudinal atrophy pattern in comparison to nondemented subjects with AD. The nonsignificant atrophy rate compared with controls suggests that increased pTau181-levels without concomitant amyloidopathy did not indicate a neurodegenerative disorder.
CRIS-Team Scopus Importer:2023-03-24
Keywords: Alzheimer disease/physiopathology*; amyloid beta-peptides/cerebrospinal fluid*; ATN classification; longitudinal studies; magnetic resonance imaging; medial temporal lobe; SNAP; tau proteins/cerebrospinal fluid*

Patellofemoral morphology and alignment: reference values and dose-response patterns for the relation to MRI features of patellofemoral osteoarthritis - Macri, E. M.; Felson, D. T.; Zhang, Y.; Guermazi, Ali; Roemer, Frank; Crossley, K. M.; Khan, K. M.; Stefanik, J. J. (Osteoarthritis and Cartilage, 2017)
We aimed to (1) determine reference values for trochlear morphology and patellofemoral (PF) alignment in adults without magnetic resonance imaging (MRI)-defined PF full thickness cartilage damage or knee pain; and (2) evaluate dose-response patterns for these measures with prevalent MRI-defined PF structural damage and/or knee pain.The Framingham Community Cohort is a population-based sample of ambulatory adults aged >=50 years. We evaluated six morphology and alignment measures using MRI (n = 985), and reported reference values (mean ± 2SD) in a subsample without MRI-defined PF full thickness cartilage damage or knee pain (n = 563). With restricted cubic spline Poisson regression, we evaluated dose-response patterns of each of the six measures with prevalent MRI-defined PF structural damage or joint pain. Our primary outcome was full thickness cartilage damage.For dose-response curves, prevalence ratios (PR) increased monotonically for all measures except patellar tilt, which rose with both lateral and medial tilt. Associations were generally strongest in the lateral PF compartment. PR for the strongest predictors of full thickness cartilage damage reached clinical relevance (PR > 1.5) at sulcus angle (SA) >=135.0°; patellar tilt angle at <=1.0° and >=15.0°; and bisect offset >=57.0%. Lateral trochlear inclination (LTI) achieved PR > 1.5 at <=23.0° for full thickness cartilage damage with pain.SA, patellar tilt, and bisect offset were most strongly associated with full thickness cartilage damage. LTI, patellar tilt and bisect offset had stronger associations with the addition of pain. These findings contribute to better identifying a subset of patients who may benefit from mechanically based interventions.
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PATELLOFEMORAL MORPHOLOGY MEASUREMENTS AND THEIR ASSOCIATIONS WITH TIBIOFEMORAL OSTEOARTHRITIS PROGRESSION: EXPLORATORY ANALYSIS ON THE OSTEOARTHRITIS INITIATIVE - Haj-Mirzaian, A.; Guermazi, A.; Pishgar, F.; Roemer, Frank; Sereni, C.; Hakky, M.; Zikria, B.; Demehri, S. (OSTEOARTHRITIS AND CARTILAGE, 2019)
CRIS-Team WoS Importer:2019-05-21

Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative - Haj-Mirzaian, Arya; Guermazi, Ali; Pishgar, Farhad; Roemer, Frank; Sereni, Christopher; Hakky, Michael; Zikria, Bashir; Demehri, Shadpour (European Radiology, 2019)
Objectives: Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI). Methods: Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT–TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall–Salvati ratio (ISR). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd–4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. P values were corrected using the Benjamini–Hochberg procedure. Results: Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Only TT–TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04–1.14), corrected p value ≤ 0.01), BMLs (OR (95% CI), 1.1 (1.04–1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05–1.14), corrected p value ≤ 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03–1.16), corrected p value = 0.02). Conclusions: Higher TT–TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression. Key Points: • Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. • Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years. • Using longitudinal MRI data, each millimeter increase of TT–TG distance is associated with a 9% (95% confidence interval, 3–16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years.
CRIS-Team Scopus Importer:2019-08-06
Keywords: Knee; Magnetic resonance imaging; Osteoarthritis

Pathogenesis and Diagnosis of Proximal Hamstring Tendinopathies. - Schroeter, Sarah; Heiß, Rafael; Hammer, Christian; Best, Raymond; Brucker, Peter; Hinterwimmer, Stefan; Grim, Casper; Engelhardt, Martin; Hotfiel, Thilo (Sportverletzung-Sportschaden, 2024)
The proximal hamstring complex is a highly vulnerable area that is especially prone to injury. Proximal hamstring tendinopathies (PHTs) remain challenging in diagnosis, treatment, rehabilitation, and prevention due to a large variety of different injuries, slow healing response, persistent symptoms, and functional impairments. PHTs are often misdiagnosed or underdiagnosed, leading to delayed treatment and therapy failure. In addition, many athletes are at a high risk of PHT recurrence, a leading cause of prolonged rehabilitation and impaired individual performance. Until now, there have been no clear criteria for the diagnosis and classification of PHT. Tendinopathies can be graded based on their symptoms and onset. Additionally, radiological characteristics exist that describe the severity of tendinopathies. The diagnosis usually includes a battery of pain provocation tests, functional tests, and imaging to ensure a proper classification. Understanding the specific tasks in the pathogenesis and diagnostic process of PHT requires knowledge of functional anatomy, injury pattern and pathophysiological mechanisms as well as examination and imaging techniques. This work provides a structured overview of the pathogenesis and diagnostic work-up of PHT, emphasizing structured examination and imaging to enable a reliable diagnosis and rapid treatment decisions.
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Patient-individualized boundary conditions for CFD simulations using time-resolved 3D angiography - Bögel, Marco; Gehrisch, Sonja; Redel, Thomas; Rohkohl, Christopher; Dörfler, Arnd; Maier, Andreas; Kowarschik, Markus; Hölter, Philip (International Journal of Computer Assisted Radiology and Surgery, 2016)
Hemodynamic simulations are of increasing interest for the assessment of aneurysmal rupture risk and treatment planning. Achievement of accurate simulation results requires the usage of several patient-individual boundary conditions, such as a geometric model of the vasculature but also individualized inflow conditions.We propose the automatic estimation of various parameters for boundary conditions for computational fluid dynamics (CFD) based on a single 3D rotational angiography scan, also showing contrast agent inflow. First the data are reconstructed, and a patient-specific vessel model can be generated in the usual way. For this work, we optimize the inflow waveform based on two parameters, the mean velocity and pulsatility. We use statistical analysis of the measurable velocity distribution in the vessel segment to estimate the mean velocity. An iterative optimization scheme based on CFD and virtual angiography is utilized to estimate the inflow pulsatility. Furthermore, we present methods to automatically determine the heart rate and synchronize the inflow waveform to the patient's heart beat, based on time-intensity curves extracted from the rotational angiogram. This will result in a patient-individualized inflow velocity curve.The proposed methods were evaluated on two clinical datasets. Based on the vascular geometries, synthetic rotational angiography data was generated to allow a quantitative validation of our approach against ground truth data. We observed an average error of approximately [Formula: see text] for the mean velocity, [Formula: see text] for the pulsatility. The heart rate was estimated very precisely with an average error of about [Formula: see text], which corresponds to about 6 ms error for the duration of one cardiac cycle. Furthermore, a qualitative comparison of measured time-intensity curves from the real data and patient-specific simulated ones shows an excellent match.The presented methods have the potential to accurately estimate patient-specific boundary conditions from a single dedicated rotational scan.
EVALuna2:23010

Patterns of autologous and nonautologous interactions between core nuclear egress complex (NEC) proteins of α‐, β‐ and γ‐herpesviruses - Häge, Sigrun; Sonntag, Eric; Borst, Eva Maria; Tannig, Pierre; Seyler, Lisa; Bäuerle, Tobias; Bailer, Susanne M.; Lee, Chung Pei; Müller, Regina; Wangen, Christina; Milbradt, Jens; Marschall, Manfred (Viruses, 2020)
Nuclear egress is a regulated process shared by α‐, β‐ and γ‐herpesviruses. The core nuclear egress complex (NEC) is composed of the membrane‐anchored protein homologs of human cytomegalovirus (HCMV) pUL50, murine cytomegalovirus (MCMV) pM50, Epstein–Barr virus (EBV) BFRF1 or varicella zoster virus (VZV) Orf24, which interact with the autologous NEC partners pUL53, pM53, BFLF2 or Orf27, respectively. Their recruitment of additional proteins leads to the assembly of a multicomponent NEC, coordinately regulating viral nucleocytoplasmic capsid egress. Here, the functionality of VZV, HCMV, MCMV and EBV core NECs was investigated by coimmunoprecipitation and confocal imaging analyses. Furthermore, a recombinant MCMV, harboring a replacement of ORF M50 by UL50, was analyzed both in vitro and in vivo. In essence, core NEC interactions were strictly limited to autologous NEC pairs and only included one measurable nonautologous interaction between the homologs of HCMV and MCMV. A comparative analysis of MCMV‐WT versus MCMV‐UL50‐infected murine fibroblasts revealed almost identical phenotypes on the levels of protein and genomic replication kinetics. In infected BALB/c mice, virus spread to lung and other organs was found comparable between these viruses, thus stating functional complementarity. In conclusion, our study underlines that herpesviral core NEC proteins are functionally conserved regarding complementarity of core NEC interactions, which were found either virus‐specific or restricted within subfamilies.
CRIS-Team Scopus Importer:2020-03-27
Keywords: Autologous vs. nonautologous interactions; Core NEC interaction properties; Core nuclear egress complexes (NECs); Degree of conservation; Functional complementarity; Multicomponent NEC recruitment of proteins; Takeover of activities in vitro and in vivo; α‐; β‐ and γ‐herpesviruses

Patterns of Coexisting Lesions Detected on Magnetic Resonance Imaging and Relationship to Incident Knee Osteoarthritis: The Multicenter Osteoarthritis Study - Niu, Jingbo; Felson, David T.; Neogi, Tuhina; Nevitt, Michael C.; Guermazi, Ali; Roemer, Frank; Lewis, Cora E.; Torner, James; Zhang, Yuqing (Arthritis and Rheumatology, 2015)
To identify patterns of coexisting lesions seen on magnetic resonance imaging (MRI) in knees that are free of radiographic osteoarthritis (OA) and to examine the relationship of these MRI-detected lesions to incident OA.Study subjects were individuals enrolled in the Multicenter Osteoarthritis Study, a prospective cohort study. In each subject, 1 knee in which radiographic OA was absent in both the tibiofemoral and patellofemoral joints at baseline was selected for study, with followup for 84 months. We used a novel approach, latent class analysis, to group the constellation of MRI lesions in each joint, i.e., cartilage damage, bone marrow lesion, meniscal tear, meniscal extrusion, synovitis, and effusion, into a manageable number of subgroups. The association of these subgroups with incident radiographic OA in the same joint was assessed using logistic regression.Among 885 eligible knees (203 with incident disease in the tibiofemoral joint, 64 with incident disease in the patellofemoral joint), 4 latent subgroups in the tibiofemoral joint were identified (described briefly as minimal lesions, mild lesions, moderate lesions [but limited meniscal lesions], and severe lesions). The odds ratios of incident tibiofemoral joint OA in the latter 3 subgroups (compared to the knees with minimal lesions as the referent) were 5.6, 1.8, and 5.0, respectively. A similar set of 4 subgroups in the patellofemoral joint was identified, except that the fourth subgroup had limited meniscal lesions. The odds ratios of incident disease in the patellofemoral joint were 3.8, 5.1, and 13.7 in the subgroups with mild lesions, moderate lesions, and severe lesions, respectively.Different patterns of coexisting MRI lesions, which have different implications with regard to risk of knee OA, were identified. Meniscal damage seemed to play a different role in the development of incident disease in tibiofemoral versus patellofemoral joints.
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Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage - Volbers, Bastian; Giede-Jeppe, Antje; Gerner, Stefan; Sembill, Jochen; Kuramatsu, Joji; Lang, Stefan; Lücking, Hannes; Staykov, Dimitre; Huttner, Hagen (Neurology, 2018)
Objective To evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify pathophysiologic factors influencing edema evolution. Methods This retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor). Results A total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62-78), median ICH volume on admission 17.7 mL (IQR 7.9-40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973-0.994]) as an independent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 [95% CI 1.018-1.103]) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 [95% CI 1.034-1.477; PSM cohort, n = 124]). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 [95% CI 1.533-8.679]) and fever burden on days 2-3 (OR 1.456 [95% CI 1.103-1.920]). Conclusion Our findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.
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Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage - Gerner, Stefan; Auerbeck, Katrin; Sprügel, Maximilian; Sembill, Jochen; Madzar, Dominik; Gölitz, Philipp; Kuramatsu, Joji; Schwab, Stefan; Huttner, Hagen; Hölter, Philip (Cerebrovascular Diseases, 2018)
Background: Troponin I is a widely used and reliable marker of myocardial damage and its levels are routinely measured in acute stroke care. So far, the influence of troponin I elevations during hospital stay on functional outcome in patients with atraumatic intracerebral hemorrhage (ICH) is unknown. Methods: Observational single-center study including conservatively treated ICH patients over a 9-year period. Patients were categorized according to peak troponin I level during hospital stay (<= 0.040, 0.041-0.500, > 0.500 ng/mL) and compared regarding baseline and hematoma characteristics. Multivariable analyses were performed to investigate independent associations of troponin levels during hospital stay with functional outcome -assessed using the modified Rankin Scale (mRS; favorable 0-3/unfavorable 4-6) -and mortality after 3 and 12 months. To account for possible con-founding propensity score (PS)-matching (1: 1; caliper 0.1) was performed accounting for imbalances in baseline characteristics to investigate the impact of troponin I values on outcome. Results: Troponin elevations (> 0.040 ng/mL) during hospital stay were observed in 308 out of 745 (41.3%) patients and associated with poorer status on admission (Glasgow Coma Scale/National Institute of Health Stroke Scale). Multivariable analysis revealed troponin I levels during hospital stay to be independently associated with unfavorable outcome after 12 months (risk ratio [95% CI]: 1.030 [1.009-1.051] per increment of 1.0 ng/mL; p = 0.005), but not with mortality. After PS-matching, patients with troponin I elevation (= 0.040 ng/mL) versus those without had a significant higher rate of -unfavorable outcome after 3 and 12 months (mRS 4-6 at 3 months: < 0.04 ng/mL: 159/265 [60.0%] versus = 0.04 ng/mL: 199/266 [74.8%]; p < 0.001; at 12 months: < 0.04 ng/mL: 141/248 [56.9%] versus <= 0.04 ng/mL: 179/251 [71.3%]; p = 0.001). Conclusions: Troponin I elevations during hospital stay occur frequently in ICH patients and are independently associated with functional outcome after 3 and 12 months but not with mortality. (c) 2018 S. Karger AG, Basel
EVALuna2:34936

Pearls & Oy-sters: Moyamoya Vasculopathy and Its Association With Congenital Heart Disease - Osterloh, Justus; Heim, Christian; Siedler, Gabriela; Engelhorn, Tobias; Dörfler, Arnd; Schwab, Stefan; Kallmünzer, Bernd (Neurology, 2021)
CRIS-Team Scopus Importer:2021-06-25

Pearls & Oy-sters: SARS-CoV-2 Infection of the CNS in a Patient With Meningeosis Carcinomatosa - Steininger, Philipp; Seifert, Frank; Balk, Stefanie; Kuramatsu, Joji; Kremer, Andreas; Coras, Roland; Engelhorn, Tobias; Maier, Clara; Tenbusch, Matthias; Korn, Klaus; Enßer, Armin (Neurology, 2021)
CRIS-Team Scopus Importer:2021-03-26

Pediatric cardiac MRI: automated left-ventricular volumes and function analysis and effects of manual adjustments - Hammon, Matthias; Janka, Rolf Matthias; Dankerl, Peter; Glöckler, Martin; Kammerer, Ferdinand J.; Dittrich, Sven; Uder, Michael; Rompel, Oliver (Pediatric Radiology, 2015)
Cardiac MRI is an accurate and reproducible technique for the assessment of left ventricular volumes and function. The accuracy of automated segmentation and the effects of manual adjustments have not been determined in children.To evaluate automated segmentation and the effects of manual adjustments for left ventricular parameter quantification in pediatric cardiac MR images.Left ventricular parameters were evaluated in 45 children with suspected myocarditis (age 13.4 ± 3.5 years, range 4-17 years) who underwent cardiac MRI. Dedicated software was used to automatically segment and adjust the parameters. Results of end-diastolic volume, end-systolic volume, stroke volume, myocardial mass, and ejection fraction were documented before and after apex/base adjustment and after apex/base/myocardial contour adjustment.The software successfully detected the left ventricle in 42 of 45 (93.3%) children; failures occurred in the smallest and youngest children. Of those 42 children, automatically segmented end-diastolic volume (EDV) was 151 ± 47 ml, and after apex/base adjustment it was 146 ± 45 ml, after apex/base/myocardial contour adjustment 146 ± 45 ml. The corresponding results for end-systolic volume (ESV) were 66 ± 32 ml, 63 ± 29 ml and 64 ± 28 ml; for stroke volume (SV) they were 85 ± 25 ml, 83 ± 23 ml and 83 ± 23 ml; for ejection fracture (EF) they were 57 ± 10%, 58 ± 9% and 58 ± 9%, and for myocardial mass (MM) they were 104 ± 31 g, 95 ± 31 g and 94 ± 30 g. Statistically significant differences were found when comparing the EDV/ESV/MM results, the EF results after apex/base adjustment and after apex/base/myocardial contour adjustment and the SV results (except for comparing the SVs after apex/base adjustment and after apex/base/myocardial contour adjustment).Automated segmentation for the evaluation of left ventricular parameters in pediatric MR images proved to be feasible. Automated segmentation + apex/base adjustment provided clinically acceptable parameters for the majority of cases.
EVALuna2:14344

Pedicle screw instrumentation of the cervicothoracic junction in the sitting position using ct-guided navigation: Application and technical aspects - Hore, Nirjhar; Lücking, Hannes; Schmitt, Hubert; Buchfelder, Michael; Brandner, Sebastian (Journal of Neurological Surgery Part A: Central European Neurosurgery, 2021)
Background We evaluate the feasibility and potential advantages of spinal CT navigation in the placement of pedicle screws at the cervicothoracic junction in the sitting position to counteract the anatomy-related limitations of 2D fluoroscopy. Methods We retrospectively analyze the data from 15 patients who underwent CT-based navigation-guided placement of a total of 36 pedicle screws at the cervicothoracic junction in the sitting position. Results CT-based spinal navigation is a useful method in increasing accuracy of pedicle screw instrumentation in the sitting position, successfully counteracting the anatomy-related limitations of 2D fluoroscopy at the cervicothoracic junction. Conclusion CT-based navigation-guided placement of pedicle screws at the cervicothoracic junction in the sitting position proved to be an accurate, safe, and user-friendly method.
CRIS-Team Scopus Importer:2021-02-26
Keywords: Cervical spine; Sitting position; Spinal navigation

Penile bulb sparing in prostate cancer radiotherapy: Dose analysis of an in-house MRI system to improve contouring - Boeckelmann, F.; Hammon, Matthias; Lettmaier, S.; Fietkau, Rainer; Bert, Christoph; Putz, Florian (Strahlentherapie und Onkologie, 2019)
ObjectiveThis study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions.Patients and methodsA total of 17prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a65cm(3) air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed acaudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5mm safety margin.ResultsIn the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (D-mean) and maximum (D-max) doses to the PB which were significantly lower (by 7.6Gy and 10.9Gy, respectively; p<0.05) than those of the CT-contoured PTV. For 6patients, the estimated PB D-max (seven-field IMRT and IBT) for the adapted PTV was <70Gy, whereas only 1patient fulfilled this criterium with the CT-based PTV.ConclusionMRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment. ZusammenfassungZielZiel war es, eine Dosisreduktion an der Peniswurzel auf Grundlage einer Magnetresonanztomographie-(MRT-)unterstutzten Konturierung unter Einhaltung eines Trink- und Rektalballonprotokolls (ERB) zu erreichen.Patienten und MethodenInsgesamt wurden 17Patienten mit Prostatakrebs intensitatsmoduliert bestrahlt (IMRT) und erhielten anschlie ss end eine interstitielle Brachytherapie (IBT). Computertomographie- (CT) und MRT-Datensatze wurden kurz nacheinander auf Basis eines 65-cm(3)-ERB- und Trinkprotokolls akquiriert und danach rigide registriert. In beiden Datensatzen wurde jeweils die Peniswurzeldosis bestimmt. Ein CT-basiertes Planungszielvolumen (PTV) wurde fur die Bestrahlungsplanung verwendet und retrospektiv mit einem MRT-basierten adaptiven PTV verglichen. Das adaptive PTV umfasst ein kaudal gekurztes CT-basiertes PTV, welches auf Grundlage einer MRT-basierten Prostatakontur und einem zusatzlichen 5-mm-Sicherheitsraum definiert wurde.ErgebnisseDas MRT-basierte adaptive PTV erzielte bei der 7-Felder-IMRT-Planung 7,6Gy (D-mean) und 10,9Gy (D-max) weniger Dosis an der Peniswurzel als das CT-konturierte PTV. Fur 6Patienten, geplant mit dem adaptiven PTV, war die abgeschatzte Maximaldosis D-max (7-Felder-IMRT+IBT) an der Peniswurzel <70Gy, wohingegen beim CT-basierten PTV nur 1Patient das Kriterium erfullte.SchlussfolgerungDie MRT-basierte Konturierung und die 7-Felder-IMRT-Planung reduzierte die Peniswurzeldosis. Die Gesamtdosis der Peniswurzel bestehend aus der 7-Felder-IMRT- und IBT-Planung zeigte sich reduziert, wobei die MRT- und CT- Konturierungsanalyse nur auf die externe 7-Felder-Bestrahlungsplanung basiert.
CRIS-Team WoS Importer:2019-02-21

Percent mammographic density and dense area as risk factors for breast cancer - Rauh, C.; Hack, Caroline; Häberle, Lothar; Hein, Alexander; Engel, Anne; Schrauder, Michael G.; Fasching, Peter; Jud, Sebastian; Ekici, Arif Bülent; Loehberg, C. R.; Meier-Meitinger, Martina; Ozan-Mergner, Sevil Julia; et al. (Geburtshilfe und Frauenheilkunde, 2012)
Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = 0.56) was stronger correlated to BMI than DA (ρ = 0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25-3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast cancer risk factor that is obtained from breast imaging. © Georg Thieme Verlag KG Stuttgart · New York.
CRIS-Team Scopus Importer:2021-07-19
Keywords: breast cancer; mammographic density; risk

Performance of Photon-Counting Breast Computed Tomography, Digital Mammography, and Digital Breast Tomosynthesis in Evaluating Breast Specimens - Rößler, Ann-Christin; Kalender, Willi Alfred; Kolditz, Daniel; Steiding, Christian; Ruth, Veikko; Preuss, Caroline; Peter, Sandra Christina; Brehm, Barbara; Hammon, Matthias; Schulz-Wendtland, Rüdiger; Wenkel, Evelyn (Academic Radiology, 2017)
This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers.A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves.Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT.pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.
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Pericardial Effusion Predicts Clinical Outcomes in Patients with COVID-19: A Nationwide Multicenter Study - Bucher, Andreas Michael; Henzel, Kristina; Meyer, Hans Jonas; Ehrengut, Constantin; Müller, Lukas; Schramm, Dominik; Akinina, Alena; Drechsel, Michelle; Kloeckner, Roman; Isfort, Peter; Sähn, Marwin Jonathan; Fink, Matthias; et al. (Academic Radiology, 2024)
Rationale and Objectives: The prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of PE in patients with Covid 19 in a large multicentre setting. Materials and Methods: This retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit (ICU) admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann–Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. Results: Overall, 46.4% of the patients were admitted to ICU, mechanical lung ventilation was performed in 26.6% and 30-day mortality was 24%. PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR = 1.54, CI 95% (1.05; 2.23), p = 0.02 (univariable analysis), and HR = 1.60, CI 95% (1.03; 2.48), p = 0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR = 1.02, CI 95% (1.003; 1.05), p = 0.03) and the need for ICU admission (OR = 1.03, CI 95% (1.005; 1.05), p = 0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR = 1.56, CI 95%(1.01–2.43), p = 0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. Conclusion: The prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.
CRIS-Team Scopus Importer:2024-01-12
Keywords: Covid 19; Mortality; Pericardial effusion

Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management - Kaemmerer, Ann-Sophie; Alkhalaileh, Khaleel; Suleiman, Mathieu; Kopp, Markus; Hauer, Christine; May, Matthias; Uder, Michael; Weyand, Michael; Harig, Frank (Journal of Cardiothoracic Surgery, 2023)
Background: Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. Conclusions: In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. Central message: A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). Perspective: Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).
CRIS-Team Scopus Importer:2023-02-17
Keywords: Cardiac tamponade; Diagnostics; Historical aspects; Pericardial effusion; Postoperative complication

Perihemorrhagic edema revisiting hematoma volume, location and surface - Sprügel, Maximilian; Kuramatsu, J. B.; Volbers, Bastian; Koelbl, K.; Gerner, Stefan; Lücking, Hannes; Dörfler, Arnd; Schwab, Stefan; Huttner, Hagen; Hölter, Philip (JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 2019)
CRIS-Team WoS Importer:2019-07-19

Perihemorrhagic edema: Revisiting hematoma volume, location, and surface - Sprügel, Maximilian; Kuramatsu, Joji; Volbers, Bastian; Gerner, Stefan; Sembill, Jochen; Madžar, Dominik; Bobinger, Tobias; Kölbl, Kathrin; Lücking, Hannes; Dörfler, Arnd; Schwab, Stefan; Huttner, Hagen; et al. (Neurology, 2019)
OBJECTIVE: To determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution. METHODS: Patients with ICH of the prospective Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution. RESULTS: Overall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface (R2 = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema (R2 = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.68-4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88-1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes. CONCLUSIONS: Peak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.
CRIS-Team Scopus Importer:2019-09-27

Peri-Prosthetic Fracture as a Rare Cause of Critical Limb Ischaemia - Li, Yi; Schmid, Axel (European Journal of Vascular and Endovascular Surgery, 2023)
CRIS-Team Scopus Importer:2023-04-28

Perivascular microglia promote blood vessel disintegration in the ischemic penumbra - Jolivel, Valérie; Bicker, Frank; Binamé, Fabien; Ploen, Robert; Keller, Stefanie; Gollan, René; Jurek, Betty; Birkenstock, Jérôme; Poisa-Beiro, Laura; Bruttger, Julia; Opitz, Verena; Thal, Serge C.; et al. (Acta Neuropathologica, 2015)
The contribution of microglia to ischemic cortical stroke is of particular therapeutic interest because of the impact on the survival of brain tissue in the ischemic penumbra, a region that is potentially salvable upon a brain infarct. Whether or not tissue in the penumbra survives critically depends on blood flow and vessel perfusion. To study the role of microglia in cortical stroke and blood vessel stability, CX3CR1(+/GFP) mice were subjected to transient middle cerebral artery occlusion and then microglia were investigated using time-lapse two-photon microscopy in vivo. Soon after reperfusion, microglia became activated in the stroke penumbra and started to expand cellular protrusions towards adjacent blood vessels. All microglia in the penumbra were found associated with blood vessels within 24 h post reperfusion and partially fully engulfed them. In the same time frame blood vessels became permissive for blood serum components. Migration assays in vitro showed that blood serum proteins leaking into the tissue provided molecular cues leading to the recruitment of microglia to blood vessels and to their activation. Subsequently, these perivascular microglia started to eat up endothelial cells by phagocytosis, which caused an activation of the local endothelium and contributed to the disintegration of blood vessels with an eventual break down of the blood brain barrier. Loss-of-microglia-function studies using CX3CR1(GFP/GFP) mice displayed a decrease in stroke size and a reduction in the extravasation of contrast agent into the brain penumbra as measured by MRI. Potentially, medication directed at inhibiting microglia activation within the first day after stroke could stabilize blood vessels in the penumbra, increase blood flow, and serve as a valuable treatment for patients suffering from ischemic stroke.
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Personalization of thoracoabdominal CT examinations using scanner integrated clinical decision support systems – Impact on the acquisition technique, scan range, and reconstruction type - Daniel, Sascha; Kopp, Markus; Vollbrecht, Thomas; Zeilinger, Martin; Fitz, Tim; Muttke, Armin; Feuerlein, Ute; Uder, Michael; May, Matthias (European Journal of Radiology, 2023)
Objectives: This study evaluates the impact of a scanner-integrated, customized clinical decision support system (CDSS) on the acquisition technique, scan range, and reconstruction in thoracoabdominal CT. Materials and Methods: We applied CDSS in contrast–enhanced examinations of the trunk with various clinical indications on a recent scanner with the capability of dual-energy CT (DECT), anatomic landmark detection (ALD), and iterative metal-artifact reduction (MAR). Simple and comprehensive questions about the patient's breath hold capability, the anatomical region of interest, and metal implants can be answered after the localizer. The acquisition technique (single energy, SECT, or dual energy), scan range (chest-abdomen-pelvis or chest-abdomen), and reconstruction technique (with or without MAR) were then automatically adapted in the examination protocols in coherence with these selections. Retrospectively, we compared the usage rates for these techniques in 624 examinations on the study scanner with 740 examinations on a comparable scanner without CDSS. Subgroup analysis of effective dose (ED), scan duration, and image quality (IQ) was performed in the study group. Results: CDSS leads to an increased usage rate of DECT (64.4% vs. 2.8%) and MAR (75.4% vs. 44.0%). All scan range adaptations by ALD were successful. The resulting subjective IQ between single energy and DECT acquisitions was comparable (all p > 0.05). Scan duration was significantly longer in DECT than in SECT (16.9 s vs. 6.5 s; p < 0.001). However, the objective IQ was significantly higher in DECT (CNRD 2.1 vs. 1.8; p < 0.01), and the ED significantly lower (6.7 mSv vs. 7.6 mSv; p = 0.004). Conclusion: CDSS for thoracoabdominal CT leads to a substantially increased usage rate of innovative techniques during acquisition and reconstruction. Patients with adapted protocols benefit from improved image quality and increased post-processing options at lower radiation doses.
CRIS-Team Scopus Importer:2023-09-29
Keywords: Clinical decision support systems; CT; Dual-energy; Metal artifact reduction; Radiation dose

Personalized Chest Computed Tomography: Minimum Diagnostic Radiation Dose Levels for the Detection of Fibrosis, Nodules, and Pneumonia - May, Matthias; Heiß, Rafael; Köhnen, Julia; Wetzl, Matthias; Wiesmüller, Marco; Treutlein, Christoph; Uder, Michael; Kopp, Markus; Bräuer, Lars (Investigative Radiology, 2022)
OBJECTIVES: The purpose of this study was to evaluate the minimum diagnostic radiation dose level for the detection of high-resolution (HR) lung structures, pulmonary nodules (PNs), and infectious diseases (IDs). MATERIALS AND METHODS: A preclinical chest computed tomography (CT) trial was performed with a human cadaver without known lung disease with incremental radiation dose using tin filter-based spectral shaping protocols. A subset of protocols for full diagnostic evaluation of HR, PN, and ID structures was translated to clinical routine. Also, a minimum diagnostic radiation dose protocol was defined (MIN). These protocols were prospectively applied over 5 months in the clinical routine under consideration of the individual clinical indication. We compared radiation dose parameters, objective and subjective image quality (IQ). RESULTS: The HR protocol was performed in 38 patients (43%), PN in 21 patients (24%), ID in 20 patients (23%), and MIN in 9 patients (10%). Radiation dose differed significantly among HR, PN, and ID (5.4, 1.2, and 0.6 mGy, respectively; P < 0.001). Differences between ID and MIN (0.2 mGy) were not significant (P = 0.262). Dose-normalized contrast-to-noise ratio was comparable among all groups (P = 0.087). Overall IQ was perfect for the HR protocol (median, 5.0) and decreased for PN (4.5), ID-CT (4.3), and MIN-CT (2.5). The delineation of disease-specific findings was high in all dedicated protocols (HR, 5.0; PN, 5.0; ID, 4.5). The MIN protocol had borderline IQ for PN and ID lesions but was insufficient for HR structures. The dose reductions were 78% (PN), 89% (ID), and 97% (MIN) compared with the HR protocols. CONCLUSIONS: Personalized chest CT tailored to the clinical indications leads to substantial dose reduction without reducing interpretability. More than 50% of patients can benefit from such individual adaptation in a clinical routine setting. Personalized radiation dose adjustments with validated diagnostic IQ are especially preferable for evaluating ID and PN lesions.
CRIS-Team Scopus Importer:2022-02-25

Personalized computed tomography - Automated estimation of height and weight of a simulated digital twin using a 3D camera and artificial intelligence - Geißler, Frederik; Heiß, Rafael; Kopp, Markus; Wiesmüller, Marco; Saake, Marc; Wüst, Wolfgang; Wimmer, Andreas; Prell, Veronika; Uder, Michael; May, Matthias (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2021)
Purpose The aim of this study was to develop an algorithm for automated estimation of patient height and weight during computed tomography (CT) and to evaluate its accuracy in everyday clinical practice. Materials and methods Depth images of 200 patients were recorded with a 3D camera mounted above the patient table of a CT scanner. Reference values were obtained using a calibrated scale and a measuring tape to train a machine learning algorithm that fits a patient avatar into the recorded patient surface data. The resulting algorithm was prospectively used on 101 patients in clinical practice and the results were compared to the reference values and to estimates by the patient himself, the radiographer and the radiologist. The body mass index was calculated from the collected values for each patient using the WHO formula. A tolerance level of 5kg was defined in order to evaluate the impact on weight-dependent contrast agent dosage in abdominal CT. Results Differences between values for height, weight and BMI were non-significant over all assessments (p > 0.83). The most accurate values for weight were obtained from the patient information (R2=0.99) followed by the automated estimation via 3D camera (R2=0.89). Estimates by medical staff were considerably less precise (radiologist: R2=0.78, radiographer: R2=0.77). A body-weight dependent dosage of contrast agent using the automated estimations matched the dosage using the reference measurements in 65 % of the cases. The dosage based on the medical staff estimates would have matched in 49 % of the cases. Conclusion Automated estimation of height and weight using a digital twin model from 3D camera acquisitions provide a high precision for protocol design in computer tomography. Key points: Machine learning can calculate patient-avatars from 3D camera acquisitions. Height and weight of the digital twins are comparable to real measurements of the patients. Estimations by medical staff are less precise. The values can be used for calculation of contrast agent dosage. Citation Format Geissler F, Heiβ R, Kopp M et al. Personalized computed tomography - Automated estimation of height and weight of a simulated digital twin using a 3D camera and artificial intelligence. Fortschr Röntgenstr 2021; 193: 437-445.
CRIS-Team Scopus Importer:2021-04-09
Keywords: 3D camera; automatic data collection; CT; digital twin; machine learning

Personalized medicine for reconstruction of critical-size bone defects – a translational approach with customizable vascularized bone tissue - Kengelbach-Weigand, Annika; Thielen, Carolina; Bäuerle, Tobias; Götzl, Rebekka; Gerber, Thomas; Körner, Carolin; Beier, Justus; Horch, Raymund E.; Boos, Anja (npj Regenerative Medicine, 2021)
Tissue engineering principles allow the generation of functional tissues for biomedical applications. Reconstruction of large-scale bone defects with tissue-engineered bone has still not entered the clinical routine. In the present study, a bone substitute in combination with mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) with or without growth factors BMP-2 and VEGF-A was prevascularized by an arteriovenous (AV) loop and transplanted into a critical-size tibia defect in the sheep model. With 3D imaging and immunohistochemistry, we could show that this approach is a feasible and simple alternative to the current clinical therapeutic option. This study serves as proof of concept for using large-scale transplantable, vascularized, and customizable bone, generated in a living organism for the reconstruction of load-bearing bone defects, individually tailored to the patient’s needs. With this approach in personalized medicine for the reconstruction of critical-size bone defects, regeneration of parts of the human body will become possible in the near future.
CRIS-Team Scopus Importer:2021-08-27

PET Imaging in Osteoarthritis - Jarraya, Mohamed; Roemer, Frank; Bäuerle, Tobias; Kogan, Feliks; Guermazi, Ali (PET Clinics, 2023)
CRIS-Team Scopus Importer:2022-12-09
Keywords: CT; MR imaging; Osteoarthritis; PET

PHOTOREALISTIC DEPICTION OF RHEUMATIC PATHOLOGIES BY CINEMATIC RENDERING FACILITATES DISEASE UNDERSTANDING OF PATIENTS WITH RHEUMATIC DISEASES - Pachowsky, Milena; Morf, Harriet; Simon, David; Schönau, Verena; Valor, L.; Knitza, Johannes; Engel, K.; Uder, Michael; Hueber, Axel; Schett, Georg; Kleyer, Arnd (ANNALS OF THE RHEUMATIC DISEASES, 2022)
CRIS-Team WoS Importer:2022-11-04

Physics-Informed Conditional Autoencoder Approach for Robust Metabolic CEST MRI at 7T - Rajput, Junaid R.; Möhle, Tim A.; Fabian, Moritz; Mennecke, Angelika; Sembill, Jochen; Kuramatsu, Joji; Schmidt, Manuel; Dörfler, Arnd; Maier, Andreas; Zaiß, Moritz (Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 2023)
Chemical exchange saturation transfer (CEST) is an MRI method that provides insights on the metabolic level. Several metabolite effects appear in the CEST spectrum. These effects are isolated by Lorentzian curve fitting. The separation of CEST effects suffers from the inhomogeneity of the saturation field B1. This leads to inhomogeneities in the associated metabolic maps. Current B1 correction methods require at least two sets of CEST-spectra. This at least doubles the acquisition time. In this study, we investigated the use of an unsupervised physics-informed conditional autoencoder (PICAE) to efficiently correct B1 inhomogeneity and isolate metabolic maps while using a single CEST scan. The proposed approach integrates conventional Lorentzian model into the conditional autoencoder and performs voxel-wise B1 correction and Lorentzian line fitting. The method provides clear interpretation of each step and is inherently generative. Thus, CEST-spectra and fitted metabolic maps can be created at arbitrary B1 levels. This is important because the B1 dispersion contains information about the exchange rates and concentration of metabolite protons, paving the way for their quantification. The isolated maps for tumor data showed a robust B1 correction and more than 25% increase in structural similarity index (SSIM) with gadolinium reference image compared to the standard interpolation-based method and subsequent Lorentzian curve fitting. This efficient correction method directly results in at least 50% reduction in scan time.
CRIS-Team Scopus Importer:2023-11-03
Keywords: Acquisition time; Bound loss; CEST; Interpretability; Lorentzian fit; Physics-informed autoencoder

Physiological effects of cigarette smoking in the limbic system revealed by 3 tesla magnetic resonance spectroscopy - Mennecke, Angelika; Gossler, Andrea; Hammen, Thilo; Dörfler, Arnd; Stadlbauer, Andreas; Roesch, Julie; Kornhuber, Johannes; Bleich, Stefan; Dölken, Marc; Thürauf, Norbert (Journal of Neural Transmission, 2014)
Several studies and recent models of effects of nicotine, the main addictive and psychoactive component in tobacco, point to action of the drug on the limbic system during maintenance of addiction, either direct or indirect via projections from the ventral tegmental area. The objective of this study was to demonstrate physiological effects of cigarette smoking on the hippocampus and the grey matter of the dorsal anterior cingulate cortex in the human brain with regard to addiction and withdrawal. This aim was achieved by group comparisons of results of magnetic resonance spectroscopy between non-smokers, smokers and smokers during withdrawal. 12 smokers and 12 non-smokers were measured with single voxel proton magnetic resonance spectroscopy for total N-acetyl aspartate, glutamate and glutamine, choline-containing compounds, myo-inositol and total creatine in the right and the left hippocampus and in the right and the left dorsal anterior cingulate cortex. Smokers were examined twice, first during regular cigarette smoking and second on the third day of nicotine withdrawal. The ratios to total creatine were used for better reliability. In our study, Glx/tCr was significantly increased and tCho/tCr was significantly decreased in the left cingulate cortex in smokers compared to non-smokers (p = 0.01, both). Six out of seven smokers showed normalization of the Glx/tCr in the left cingulate cortex during withdrawal. Although these results are preliminary due to the small sample size, our results confirm the assumption that cigarette smoking interferes directly or indirectly with the glutamate circuit in the dorsal anterior cingulate cortex.
EVALuna2:22826

Physiological MRI Biomarkers in the Differentiation Between Glioblastomas and Solitary Brain Metastases - Heynold, Elisabeth; Zimmermann, Max; Hore, Nirjhar; Buchfelder, Michael; Dörfler, Arnd; Stadlbauer, Andreas; Kremenevski, Natalia (Molecular Imaging and Biology, 2021)
Purpose: Glioblastomas (GB) and solitary brain metastases (BM) are the most common brain tumors in adults. GB and BM may appear similar in conventional magnetic resonance imaging (cMRI). Their management strategies, however, are quite different with significant consequences on clinical outcome. The aim of this study was to evaluate the usefulness of a previously presented physiological MRI approach scoping to obtain quantitative information about microvascular architecture and perfusion, neovascularization activity, and oxygen metabolism to differentiate GB from BM. Procedures: Thirty-three consecutive patients with newly diagnosed, untreated, and histopathologically confirmed GB or BM were preoperatively examined with our physiological MRI approach as part of the cMRI protocol. Results: Physiological MRI biomarker maps revealed several significant differences in the pathophysiology of GB and BM: Central necrosis was more hypoxic in GB than in BM (30 %; P = 0.036), which was associated with higher neovascularization activity (65 %; P = 0.043) and metabolic rate of oxygen (48 %; P = 0.004) in the adjacent contrast-enhancing viable tumor parts of GB. In peritumoral edema, GB infiltration caused neovascularization activity (93 %; P = 0.018) and higher microvascular perfusion (30 %; P = 0.022) associated with higher tissue oxygen tension (33 %; P = 0.020) and lower oxygen extraction from vasculature (32 %; P = 0.040). Conclusion: Our physiological MRI approach, which requires only 7 min of extra data acquisition time, might be helpful to noninvasively distinguish GB and BM based on pathophysiological differences. However, further studies including more patients are required.
CRIS-Team Scopus Importer:2021-05-07
Keywords: Angiogenesis; Brain metastasis; Glioblastoma; Hypoxia; Physiological MRI

Physiological MRI of microvascular architecture, neovascularization activity, and oxygen metabolism facilitate early recurrence detection in patients with IDH-mutant WHO grade 3 glioma - Stadlbauer, Andreas; Heinz, Gertraud; Oberndorfer, Stefan; Zimmermann, Max; Kinfe, Thomas Mehari; Buchfelder, Michael; Dörfler, Arnd; Kremenevski, Natalia; Marhold, Franz (Neuroradiology, 2021)
Purpose: This study aimed to determine the diagnostic performance of physiological MRI biomarkers including microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension for recurrence detection of IDH-mutant WHO grade 3 glioma. Methods: Sixty patients with IDH-mutant WHO grade 3 glioma who received overall 288 follow-up MRI examinations at 3 Tesla after standard treatment were retrospectively evaluated. A conventional MRI protocol was extended with a physiological MRI approach including vascular architecture mapping and quantitative blood-oxygen-level-dependent imaging which required 7 min extra data acquisition time. Custom-made MATLAB software was used for the calculation of MRI biomarker maps of microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension. Statistical procedures included receiver operating characteristic analysis. Results: Overall, 34 patients showed recurrence of the WHO grade 3 glioma; of these, in 15 patients, recurrence was detected one follow-up examination (averaged 160 days) earlier by physiological MRI data than by conventional MRI. During this time period, the tumor volume increased significantly (P = 0.001) on average 7.4-fold from 1.5 to 11.1 cm3. Quantitative analysis of MRI biomarkers demonstrated microvascular but no macrovascular hyperperfusion in early recurrence. Neovascularization activity (AUC = 0.833), microvascular perfusion (0.682), and oxygen metabolism (0.661) showed higher diagnostic performance for early recurrence detection of WHO grade 3 glioma compared to conventional MRI including cerebral blood volume (0.649). Conclusion: This study demonstrated that the targeted assessment of microvascular features and tissue oxygen tension as an early sign of neovascularization activity provided valuable information for recurrence diagnostic of WHO grade 3 glioma.
CRIS-Team Scopus Importer:2021-06-23
Keywords: Glioma; Humans; Magnetic resonance imaging; Neoplasm recurrence; Neovascularization; Oxygen metabolism; Treatment failure

Physiologic MR imaging of the tumor microenvironment revealed switching of metabolic phenotype upon recurrence of glioblastoma in humans - Stadlbauer, Andreas; Oberndorfer, Stefan; Zimmermann, Max; Renner, Bertold; Buchfelder, Michael; Heinz, Gertraud; Dörfler, Arnd; Kleindienst, Andrea; Roessler, Karl (Journal of Cerebral Blood Flow and Metabolism, 2019)
Treating recurrent glioblastoma (GB) is one of the challenges in modern neurooncology. Hypoxia, neovascularization, and energy metabolism are of crucial importance for therapy failure and recurrence. Twenty-one patients with initially untreated GB who developed recurrence were examined with a novel MRI approach for noninvasive visualization of the tumor microenvironment (TME). Imaging biomarker information about oxygen metabolism (mitochondrial oxygen tension) and neovascularization (microvascular density and type) were fused for classification of five different TME compartments: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation, and glycolysis. Volume percentages of these TME compartments were compared between untreated and recurrent GB. At initial diagnosis, all 21 GB showed either the features of a glycolytic dominant phenotype with a high percentage of functional neovasculature (N = 12) or those of a necrotic/hypoxic dominant phenotype with a high percentage of defective tumor neovasculature (N = 9). At recurrence, all 21 GB revealed switching of the initial metabolic phenotype: either from the glycolytic to the necrotic/hypoxic dominant phenotype or vice-versa. A necrotic/hypoxic phenotype at recurrence was associated with a higher rate of multifocality of the recurrent lesions. Our MRI approach may be helpful for a better understanding of treatment-induced metabolic phenotype switching and for future studies developing targeted therapeutic strategies for recurrent GB.
CRIS-Team Scopus Importer:2020-02-21
Keywords: angiogenesis; Glioblastoma; hypoxia; recurrence; treatment failure; tumor microenvironment

Physiologic MR imaging of the tumor microenvironment revealed switching of metabolic phenotype upon recurrence of glioblastoma in humans - Stadlbauer, Andreas; Oberndorfer, Stefan; Zimmermann, Max; Renner, Bertold; Buchfelder, Michael; Heinz, Gertraud; Dörfler, Arnd; Kleindienst, Andrea; Roessler, Karl (Journal of Cerebral Blood Flow and Metabolism, 2020)
Treating recurrent glioblastoma (GB) is one of the challenges in modern neurooncology. Hypoxia, neovascularization, and energy metabolism are of crucial importance for therapy failure and recurrence. Twenty-one patients with initially untreated GB who developed recurrence were examined with a novel MRI approach for noninvasive visualization of the tumor microenvironment (TME). Imaging biomarker information about oxygen metabolism (mitochondrial oxygen tension) and neovascularization (microvascular density and type) were fused for classification of five different TME compartments: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation, and glycolysis. Volume percentages of these TME compartments were compared between untreated and recurrent GB. At initial diagnosis, all 21 GB showed either the features of a glycolytic dominant phenotype with a high percentage of functional neovasculature (N = 12) or those of a necrotic/hypoxic dominant phenotype with a high percentage of defective tumor neovasculature (N = 9). At recurrence, all 21 GB revealed switching of the initial metabolic phenotype: either from the glycolytic to the necrotic/hypoxic dominant phenotype or vice-versa. A necrotic/hypoxic phenotype at recurrence was associated with a higher rate of multifocality of the recurrent lesions. Our MRI approach may be helpful for a better understanding of treatment-induced metabolic phenotype switching and for future studies developing targeted therapeutic strategies for recurrent GB.
EVALuna2:212798

Pigmented villonodular synovitis. A rare differential diagnosis of synovial joint swelling - Jendrissek, Andreas; Hotfiel, Thilo; Swoboda, Bernd; Söder, Stephan; Janka, Rolf Matthias (Zeitschrift für Rheumatologie, 2016)
Pigmented villonodular synovitis (PVNS) describes a rare disease caused by an abnormal proliferation of the synovial membrane in large and small joints. In order to achieve an optimal result of treatment it is necessary to carry out specific diagnostics and a targeted therapy approach.This article gives a review of the epidemiology, etiopathogenesis and diagnostic management of PVNS as well as presenting the current therapy and treatment recommendations.A systematic search of the literature was performed in the databank of the National Center for Biotechnology Information ( http://www.ncbi.nlm.nih.gov/pubmed ). The search targeted randomized clinical and experimental studies, systematic and non-systematic review articles, expert opinions and case reports related to PVNS, independent of the level of evidence attained by each study.The differential diagnosis of PVNS should be considered in cases of recurrent hemorrhagic joint effusions. The cause of the disease has not yet been exactly clarified. The final diagnosis can ultimately only be confirmed by histological investigations. In order to obtain representative histological tissue samples for the diagnosis, magnetic resonance imaging (MRI) with the appropriate heme sequences should be carried out prior to taking samples. The management of PVNS is often difficult due to the high risk of recurrence depending on the various forms. In view of the high rate of recurrence, therapy should include a complete synovectomy.For the surgical approach arthroscopic and open procedures have been described, which are currently controversially discussed with respect to the complication and recurrence rates. Adjuvant interventional therapy forms, such as radiosynoviorthesis are recommended to reduce the recurrence rate.
EVALuna2:6817

PIK3CA mutation testing as a valuable molecular surrogate for lipomatosis of the median nerve: clinicopathological and molecular analysis of six cases - Osterloh, Justus; Agaimy, Abbas; Fried, Frederick; Stöhr, Robert; Janka, Rolf Matthias; Arkudas, Andreas; Horch, Raymund E. (Virchows Archiv, 2023)
Lipomatosis of peripheral nerves (LPN, also known as fibrolipomatous or lipofibromatous hamartoma of peripheral nerves) is a very rare, benign, intraneural, tumorous lesion that predominantly involves the median nerve but may rarely affect any peripheral nerve. Recently, PIK3CA mutations have been reported in macrodactyly, a rare condition related to LPN, and in other localized lipomatous overgrowth syndromes. In this retrospective study, we report 6 cases of FPN involving the median nerve (4 of them identified among 570 patients with carpal tunnel syndrome who underwent surgical decompression at our center from 2012 to 2022 and two seen in consultation by one of the authors). All cases were diagnosed via biopsy or resection supplemented by MRI. Patients were 4 males and 2 females aged 23 to 60 years (mean 38 years). One patient with bilateral lesions had in addition extensive angiomatosis of the paravertebral region. Histological examination showed an abnormal amount of mature fatty tissue containing disordered fibrous bands, entrapping normal-looking nerve fibers with prominent perineurial and endoneurial fibrosis. Genetic analysis using snapshot assay constructed to detect hotspots mutations in PIK3CA revealed similar PIK3CA mutations (p.H1047R; c.3140A>G) in 5/6 cases (83.3%). Our study represents a further contribution to the literature on LPN and highlights the diagnostic value of PIK3CA mutation testing as surrogate tool in equivocal cases and in those lesions without associated macrodactyly, especially as the biopsy findings of this lesion are essentially nonspecific.
CRIS-Team Scopus Importer:2023-04-28
Keywords: Everolimus; Lipomatosis; mTOR; Neuropathy; Peripheral nerves; Sequencing

Pilot study using intraoperative fluorescence angiography during arteriovenous hemodialysis access surgery - Regus, Susanne; Klingler, Felix; Lang, Werner; Meyer, Alexander; Almási-Sperling, Veronika; May, Matthias; Wüst, Wolfgang; Rother, Ulrich (Journal of Vascular Access, 2019)
Introduction: In this pilot study, we used indocyanine green fluorescence angiography during hemodialysis access surgery. The aim was to evaluate its relevance as a diagnostic tool to visualize changes in hand microperfusion. Patients and methods: In this prospective single-center study, 47 adult patients (33 male, 14 female) with renal disease (24 preemptive, 23 endstage) were enrolled. Surgical creation of an arteriovenous fistula was performed (22 forearm, 25 upper arm). Microperfusion of the ipsilateral hand and fingers was evaluated intraoperatively using indocyanine green fluorescence angiography. We compared the cumulated microperfusion parameters ingress (In) and ingress rate (InR) before and after opening of the anastomosis. To compare the dimension of microcirculatory decline, we calculated the ratios of the parameters (RatioIn and RatioInR) after to those before anastomosis opening. Results: The cumulated microperfusion parameters In and InR showed a significant decrease after completion of anastomosis and declamping. This effect has been seen in all patients for the hand and for each finger consecutively. During follow-up (mean 4.6, range 3-11 months), 5 patients (10.6%) complained about hemodialysis access-induced distal ischemia. The ratio of intraoperative microperfusion in those five hemodialysis access-induced ischemia patients was significantly lower compared to asymptomatic patients (RatioIn 0.23 vs 0.58, p = 0.001, and RatioInR 0.25 vs 0.62, p = 0.003). Conclusion: Intraoperative fluorescence angiography could visualize the deterioration of ipsilateral hand microperfusion after surgical creation of an arteriovenous fistula. It seems to be a promising tool to detect patients at risk for hemodialysis access-induced distal ischemia early in the peri- or even intraoperative stage.
CRIS-Team WoS Importer:2019-03-06

PoCaP Corpus: A Multimodal Dataset for Smart Operating Room Speech Assistant Using Interventional Radiology Workflow Analysis - Demir, Kubilay; May, Matthias; Schmid, Axel; Uder, Michael; Breininger, Katharina; Weise, Tobias; Maier, Andreas; Yang, Seung Hee (Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 2022)
This paper presents a new multimodal interventional radiology dataset, called PoCaP (Port Catheter Placement) Corpus. This corpus consists of speech and audio signals in German, X-ray images, and system commands collected from 31 PoCaP interventions by six surgeons with average duration of 81.4 ± 41.0 min. The corpus aims to provide a resource for developing a smart speech assistant in operating rooms. In particular, it may be used to develop a speech-controlled system that enables surgeons to control the operation parameters such as C-arm movements and table positions. In order to record the dataset, we acquired consent by the institutional review board and workers’ council in the University Hospital Erlangen and by the patients for data privacy. We describe the recording set-up, data structure, workflow and preprocessing steps, and report the first PoCaP Corpus speech recognition analysis results with 11.52% word error rate using pretrained models. The findings suggest that the data has the potential to build a robust command recognition system and will allow the development of a novel intervention support systems using speech and image processing in the medical domain.
CRIS-Team Scopus Importer:2022-10-14
Keywords: Automatic speech recognition; Interventional radiology; Multimodal interventional corpus; Operating room smart assistant; Port catheter placement; Surgical data science

PoCaPNet: A Novel Approach for Surgical Phase Recognition Using Speech and X-Ray Images - Yang, Seung Hee; Demir, Kubilay; Weise, Tobias; Schmid, Axel; May, Matthias; Maier, Andreas (International Conference Interspeech 2023, 2023)
Surgical phase recognition is a challenging and necessary task for the development of context-aware intelligent systems that can support medical personnel for better patient care and effective operating room management. In this paper, we present a surgical phase recognition framework that employs a Multi-Stage Temporal Convolution Network using speech and X-Ray images for the first time. We evaluate our proposed approach using our dataset that comprises 31 port-catheter placement operations and report 82.56 % frame-wise accuracy with eight surgical phases. Additionally, we investigate the design choices in the temporal model and solutions for the class-imbalance problem. Our experiments demonstrate that speech and X-Ray data can be effectively utilized for surgical phase recognition, providing a foundation for the development of speech assistants in operating rooms of the future.
Keywords: surgical workflow; surgical phase recognition; speech assistant; port-catheter placement; TCN

Population-based cohort imaging: skeletal muscle mass by magnetic resonance imaging in correlation to bioelectrical-impedance analysis - Kiefer, Lena S.; Fabian, Jana; Rospleszcz, Susanne; Lorbeer, Roberto; Machann, Jurgen; Kraus, Mareen S.; Fischer, Marc; Roemer, Frank; Rathmann, Wolfgang; Meisinger, Christa; Heier, Margit; Nikolaou, Konstantin; et al. (Journal of Cachexia, Sarcopenia and Muscle, 2022)
Background: Skeletal muscle mass is subjected to constant changes and is considered a good predictor for outcome in various diseases. Bioelectrical-impedance analysis (BIA) and magnetic resonance imaging (MRI) are approved methodologies for its assessment. However, muscle mass estimations by BIA may be influenced by excess intramuscular lipids and adipose tissue in obesity. The objective of this study was to evaluate the feasibility of quantitative assessment of skeletal muscle mass by MRI as compared with BIA. Methods: Subjects from a population-based cohort underwent BIA (50 kHz, 0.8 mA) and whole-body MRI including chemical-shift encoded MRI (six echo times). Abdominal muscle mass by MRI was quantified as total and fat-free cross-sectional area by a standardized manual segmentation-algorithm and normalized to subjects' body height2 (abdominal muscle mass indices: AMMIMRI). Results: Among 335 included subjects (56.3 ± 9.1 years, 56.1% male), 95 (28.4%) were obese (BMI ≥ 30 kg/m2). MRI-based and BIA-based measures of muscle mass were strongly correlated, particularly in non-obese subjects [r < 0.74 in non-obese (P < 0.001) vs. r < 0.56 in obese (P < 0.001)]. Median AMMITotal(MRI) was significantly higher in obese as compared with non-obese subjects (3246.7 ± 606.1 mm2/m2 vs. 2839.0 ± 535.8 mm2/m2, P < 0.001, respectively), whereas the ratio AMMIFat-free/AMMITotal (by MRI) was significantly higher in non-obese individuals (59.3 ± 10.1% vs. 53.5 ± 10.6%, P < 0.001, respectively). No significant difference was found regarding AMMIFat-free(MRI) (P = 0.424). In analyses adjusted for age and sex, impaired glucose tolerance and measures of obesity were significantly and positively associated with AMMITotal(MRI) and significantly and inversely with the ratio AMMIFat-free(MRI)/AMMITotal(MRI) (P < 0.001). Conclusions: MRI-based assessment of muscle mass is feasible in population-based imaging and strongly correlated with BIA. However, the observed weaker correlation in obese subjects may explain the known limitation of BIA in obesity and promote MRI-based assessments. Thus, skeletal muscle mass parameters by MRI may serve as practical imaging biomarkers independent of subjects' body weight.
CRIS-Team Scopus Importer:2022-02-04

Position Paper of the DRG, DGNR, GPR, DeGIR, ORG and DGP on the Use of clinical Data for scientific Purposes - Kuhl, Christiane; Walter, Peter; Zimmer, Claus; Mentzel, Hans-Joachim; Reimer, Peter; Hausegger, Klaus A.; Baretton, Gustavo; Hoffmann, Ralf-Thorsten; Heindel, Walter; Dueber, Christoph; Uder, Michael; Nikolaou, Konstantin; et al. (Röfo: Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2021)
CRIS-Team WoS Importer:2021-02-19

Position Paper on Magnetic Resonance Imaging as a non-specialist Service - Ludwig, Kathrin; Eisenkolb, Alexander; Hering, Jan Philipp; Rehbock, Beate; Bayerl, Nadine; Hofmann-Preiss, Karina; Kraus, Thomas (Röfo: Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2021)
CRIS-Team WoS Importer:2021-10-15

Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application - Kemmler, Wolfgang; Froehlich, Michael; Ludwig, Oliver; Eifler, Christoph; von Stengel, Simon; Willert, Sebastian; Teschler, Marc; Weißenfels, Anja; Kleinoeder, Heinz; Micke, Florian; Wirtz, Nicolas; Zinner, Christoph; et al. (Frontiers in Physiology, 2023)
Whole-Body Electromyostimulation (WB-EMS) is a training technology that enables simultaneous stimulation of all the main muscle groups with a specific impulse intensity for each electrode. The corresponding time-efficiency and joint-friendliness of WB-EMS may be particularly attractive for people unable or unmotivated to conduct (intense) conventional training protocols. However, due to the enormous metabolic and musculoskeletal impact of WB-EMS, particular attention must be paid to the application of this technology. In the past, several scientific and newspaper articles reported severe adverse effects of WB-EMS. To increase the safety of commercial non-medical WB-EMS application, recommendations "for safe and effective whole-body electromyostimulation" were launched in 2016. However, new developments and trends require an update of these recommendations to incorporate more international expertise with demonstrated experience in the application of WB-EMS. The new version of these consensus-based recommendations has been structured into 1) "general aspects of WB-EMS", 2) "preparation for training", recommendations for the 3) "WB-EMS application" itself and 4) "safety aspects during and after training". Key topics particularly addressed are 1) consistent and close supervision of WB-EMS application, 2) mandatory qualification of WB-EMS trainers, 3) anamnesis and corresponding consideration of contraindications prior to WB-EMS, 4) the participant's proper preparation for the session, 5) careful preparation of the WB-EMS novice, 6) appropriate regeneration periods between WB-EMS sessions and 7) continuous interaction between trainer and participant at a close physical distance. In summary, we are convinced that the present guideline will contribute to greater safety and effectiveness in the area of non-medical commercial WB-EMS application.
CRIS-Team WoS Importer:2023-05-05

Possibilities of a Seed Control after the Implantation by using MRI and Deep Learning-based QSM Reconstruction - Grigo, Johanna; Karius, Andre; Hanspach, Jannis; Weissmann, Thomas; Laun, Frederik Bernd; Strnad, Vratislav; Putz, Florian; Bert, Christoph (STRAHLENTHERAPIE UND ONKOLOGIE, 2022)
CRIS-Team WoS Importer:2022-06-03

POSSIBLE COMPLICATIONS FROM INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN THE HIP AND KNEE. AN ILLUSTRATIVE REPORT. - Guermazi, A.; Kompel, A. J.; Murakami, A.; Diaz, L.; Crema, M. D.; Roemer, Frank (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-05-29

Possible Impact of functional active GPCR-autoantibodies on retinal microcirculation in Long-COVID - Mardin, Christian Y.; Lucio, Marianna; Wallukat, Gerd; Szewczykowski, Charlotte; Hoffmanns, Jacob; Raith, Franziska; Schröder, Tim; Schottenhamml, Julia; Lämmer, Robert; Hohberger, Bettina (INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, 2022)
CRIS-Team WoS Importer:2022-09-30

Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses - Hayashi, Daichi; Roemer, Frank; D'Hooghe, Pieter; Guermazi, Ali (European Journal of Radiology, 2015)
Posterior ankle impingement is a clinical diagnosis which can be seen following a traumatic hyper-plantar flexion event and may lead to painful symptoms in athletes such as female dancers ('en pointe'), football players, javelin throwers and gymnasts. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion, and can be due to osseous or soft tissue lesions. There are multiple causes of posterior ankle impingement. Most commonly, the structural correlates of impingement relate to post-traumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences. The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses.
EVALuna2:14539

Potential for Radiation Dose Reduction in Dual-Source Computed Tomography of the Lung in the Pediatric and Adolescent Population Compared to Digital Radiography - Wetzl, Matthias; May, Matthias; Weinmann, Daniel; Hammon, Matthias; Kopp, Markus; Ruppel, Renate; Trollmann, Regina; Wölfle, Joachim; Uder, Michael; Rompel, Oliver (Diagnostics, 2021)
Low-dose dual-source computed tomography (DSCT) protocols for the evaluation of lung diseases in children and adolescents are of importance since this age group is particularly prone to radiation damage. The aim of this study was to evaluate image quality of low-dose DSCT of the lung and to assess the potential of radiation dose reduction compared to digital radiographs (DR). Three groups, each consisting of 19 patients, were examined with different DSCT protocols using tin prefiltration (Sn96/64/32 ref. mAs at 100 kV). Different strengths of iterative reconstruction were applied (ADMIRE 2/3/4). DSCT groups were compared to 19 matched patients examined with posterior-anterior DR. Diagnostic confidence, detectability of anatomical structures and small lung lesions were evaluated on a 4-point Likert scale (LS 1 = unacceptable, 4 = fully acceptable; a value >= 3 was considered acceptable). Effective dose (ED) was 31-/21-/9-fold higher in Sn96/Sn64/Sn32 compared to DR. Diagnostic confidence was sufficient in Sn96/Sn64 (LS 3.4/3.2), reduced in Sn32 (LS 2.7) and the worst in DR (LS 2.4). In DSCT, detectability of small anatomical structures was always superior to DR (p < 0.05). Mean lesion size ranged from 5.1-7 mm; detectability was acceptable in all DSCT groups (LS 3.0-3.4) and superior to DR (LS 1.9; p < 0.05). Substantial dose lowering in DSCT of the pediatric lung enables acceptable detectability of small lung lesions with a radiation dose being about 10-fold higher compared to DR.
CRIS-Team WoS Importer:2021-03-12

Potential Limitations of Established Blood-Dosimetry Models for Lu-177 Therapy - Ritt, Philipp; Jobic, C.; Grings, Andreas; Beck, Michael; Schmidkonz, Christian; Kuwert, Torsten; Uder, Michael; Brand, Michael (EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, 2021)
CRIS-Team WoS Importer:2022-01-07

Potential of Sodium MRI as a Biomarker for Neurodegeneration and Neuroinflammation in Multiple Sclerosis - Huhn, Konstantin; Engelhorn, Tobias; Linker, Ralf A.; Nagel, Armin Michael (Frontiers in Neurology, 2019)
In multiple sclerosis (MS), experimental and ex vivo studies indicate that pathologic intra-and extracellular sodium accumulation may play a pivotal role in inflammatory as well as neurodegenerative processes. Yet, in vivo assessment of sodium in the microenvironment is hard to achieve. Here, sodium magnetic resonance imaging ((NaMRI)-Na-23) with its non-invasive properties offers a unique opportunity to further elucidate the effects of sodium disequilibrium in MS pathology in vivo in addition to regular proton based MRI. However, unfavorable physical properties and low in vivo concentrations of sodium ions resulting in low signal-to-noise-ratio (SNR) as well as low spatial resolution resulting in partial volume effects limited the application of (NaMRI)-Na-23. With the recent advent of high-field MRI scanners and more sophisticated sodium MRI acquisition techniques enabling better resolution and higher SNR, (NaMRI)-Na-23 revived. These studies revealed pathologic total sodium concentrations in MS brains now even allowing for the (partial) differentiation of intra-and extracellular sodium accumulation. Within this review we (1) demonstrate the physical basis and imaging techniques of (NaMRI)-Na-23 and (2) analyze the present and future clinical application of (NaMRI)-Na-23 focusing on the field of MS thus highlighting its potential as biomarker for neuroinflammation and -degeneration.
CRIS-Team WoS Importer:2019-02-22

Potential of spiral breast computed tomography to increase patient comfort compared to DM - Wetzl, Matthias; Wenkel, Evelyn; Dietzel, Matthias; Siegler, Lisa; Emons, Julius; Dethlefsen, Ebba; Heindl, Felix; Kuhl, Christiane; Uder, Michael; Ohlmeyer, Sabine (European Journal of Radiology, 2021)
Purpose: To intra-individually compare patient comfort of spiral breast computed tomography (SBCT) versus digital mammography (DM).
CRIS-Team WoS Importer:2022-02-04

Practicability of hygienic wrapping of touchscreen operated mobile devices in a clinical setting - Hammon, Matthias; Kunz, Hans Bernd; Dinzl, Veronika; Kammerer, Ferdinand J.; Schwab, Siegfried; Bogdan, Christian; Uder, Michael; Schlechtweg, Philipp (PLoS ONE, 2014)
To prove effectiveness of wrapping tablet computers in order to reduce microbiological contamination and to evaluate whether a plastic bag-covered tablet leads to impaired user satisfaction or touchscreen functionality.Within a period of 11 days 115 patients were provided with a tablet computer while waiting for their magnetic resonance imaging examination. Every day the contamination of the surface of the tablet was determined before the first and after the final use. Before the device was handed over to a patient, it was enclosed in a customized single-use plastic bag, which was analyzed for bacterial contamination after each use. A questionnaire was applied to determine whether the plastic bag impairs the user satisfaction and the functionality of the touchscreen.Following the use by patients the outside of the plastic bags was found to be contaminated with various bacteria (657.5 ± 368.5 colony forming units/day); some of them were potentially pathogenic. In contrast, the plastic bag covered surface of the tablet was significantly less contaminated (1.7 ± 1.9 colony forming units/day). Likewise, unused plastic bags did not show any contamination. 11% of the patients reported problems with the functionality of the touchscreen. These patients admitted that they had never used a tablet or a smartphone before.Tablets get severely contaminated during usage in a clinical setting. Wrapping with a customized single-use plastic bag significantly reduces microbiological contamination of the device, protects patients from the acquisition of potentially pathogenic bacteria and hardly impairs the user satisfaction and the functionality of the touchscreen.
EVALuna2:7657

Precision Learning: Reconstruction Filter Kernel Discretization - Syben-Leisner, Christopher; Stimpel, Bernhard; Breininger, Katharina; Würfl, Tobias; Fahrig, Rebecca; Dörfler, Arnd; Maier, Andreas (Proceedings of the 5th International Conference on Image Formation in X-ray Computed Tomography, 2018)
UnivIS-Import:2018-09-11:Pub.2018.tech.IMMD.IMMD5.precis_0

Precision of handheld multispectral optoacoustic tomography for muscle imaging - Wagner, Anna; Danko, Vera; Federle, Anna; Klett, Daniel; Simon, David; Heiß, Rafael; Jüngert, Jörg M.; Uder, Michael; Schett, Georg; Neurath, Markus; Wölfle, Joachim; Waldner, Maximilian; et al. (Photoacoustics, 2021)
Photo-or optoacoustic imaging (OAI) allows quantitative imaging of target tissues. Using multi-wavelength illumination with subsequent ultrasound detection, it may visualize a variety of different chromophores at centimeter depth. Despite its non-invasive, label-free advantages, the precision of repeated measurements for clinical applications is still elusive. We present a multilayer analysis of n = 1920 imaging datasets obtained from a prospective clinical trial (NCT03979157) in n = 10 healthy adult volunteers. All datasets were analyzed for 13 single wavelengths (SWL) between 660 nm–1210 nm and five MSOT-parameters (deoxygenated/oxygenated/total hemoglobin, collagen and lipid) by a semi-automated batch mode software. Intraclass correlation coefficients (ICC) were good to excellent for intrarater (SWL: 0.82–0.92; MSOT-parameter: 0.72−0.92) and interrater reproducibility (SWL: 0.79−0.87; MSOT-parameter: 0.78−0.86), with the exception for MSOT-parameter lipid (interrater ICC: 0.56). Results were stable over time, but exercise-related effects as well as inter-and intramuscular variability were observed. The findings of this study provide a framework for further clinical OAI implementation.
CRIS-Team Scopus Importer:2020-12-25
Keywords: MSOT; Multispectral optoacoustic tomography; Muscle imaging; Optoacoustics; Photoacoustics

Preclinical transgenic and patient-derived xenograft models recapitulate the radiological features of human adamantinomatous craniopharyngioma - Boult, Jessica K.R.; Apps, John R.; Hölsken, Annett; Hutchinson, J. Ciaran; Carreno, Gabriela; Danielson, Laura S.; Smith, Laura M.; Bäuerle, Tobias; Buslei, Rolf; Buchfelder, Michael; Virasami, Alex K.; Koers, Alexander; et al. (Brain Pathology, 2017)
To assess the clinical relevance of transgenic and patient-derived xenograft models of adamantinomatous craniopharyngioma (ACP) using serial magnetic resonance imaging (MRI) and high resolution post-mortem microcomputed tomography (?-CT), with correlation with histology and human ACP imaging. The growth patterns and radiological features of tumors arising in Hesx1(Cre/+) ;Ctnnb1(lox(ex3)/+) transgenic mice, and of patient-derived ACP xenografts implanted in the cerebral cortex, were monitored longitudinally in vivo with anatomical and functional MRI, and by ex vivo ?-CT at study end. Pathological correlates with hematoxylin and eosin stained sections were investigated. Early enlargement and heterogeneity of Hesx1(Cre/+) ;Ctnnb1(lox(ex3)/+) mouse pituitaries was evident at initial imaging at 8 weeks, which was followed by enlargement of a solid tumor, and development of cysts and hemorrhage. Tumors demonstrated MRI features that recapitulated those of human ACP, specifically, T1 -weighted signal enhancement in the solid tumor component following Gd-DTPA administration, and in some animals, hyperintense cysts on FLAIR and T1 -weighted images. Ex vivo ?-CT correlated with MRI findings and identified smaller cysts, which were confirmed by histology. Characteristic histological features, including wet keratin and calcification, were visible on ?-CT and verified by histological sections of patient-derived ACP xenografts. The Hesx1(Cre/+) ;Ctnnb1(lox(ex3)/+) transgenic mouse model and cerebral patient-derived ACP xenografts recapitulate a number of the key radiological features of the human disease and provide promising foundations for in vivo trials of novel therapeutics for the treatment of these tumors.
EVALuna2:14627

Predicting Glioblastoma Response to Bevacizumab Through MRI Biomarkers of the Tumor Microenvironment - Stadlbauer, Andreas; Roessler, Karl; Zimmermann, Max; Buchfelder, Michael; Kleindienst, Andrea; Dörfler, Arnd; Heinz, Gertraud; Oberndorfer, Stefan (Molecular Imaging and Biology, 2019)
Purpose: Glioblastoma (GB) is one of the most vascularized of all solid tumors and, therefore, represents an attractive target for antiangiogenic therapies. Many lesions, however, quickly develop escape mechanisms associated with changes in the tumor microenvironment (TME) resulting in rapid treatment failure. To prevent patients from adverse effects of ineffective therapy, there is a strong need to better predict and monitor antiangiogenic treatment response. Procedures: We utilized a novel physiological magnetic resonance imaging (MRI) method combining the visualization of oxygen metabolism and neovascularization for classification of five different TME compartments: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation, and aerobic glycolysis. This approach, termed TME mapping, was used to monitor changes in tumor biology and pathophysiology within the TME in response to bevacizumab treatment in 18 patients with recurrent GB. Results: We detected dramatic changes in the TME by rearrangement of its compartments after the onset of bevacizumab treatment. All patients showed a decrease in active tumor volume and neovascularization as well as an increase in hypoxia and necrosis in the first follow-up after 3 months. We found that recurrent GB with a high percentage of neovascularization and active tumor before bevacizumab onset showed a poor or no treatment response. Conclusions: TME mapping might be useful to develop strategies for patient stratification and response prediction before bevacizumab onset.
CRIS-Team Scopus Importer:2019-07-19
Keywords: Angiogenesis; Antiangiogenic therapy; Bevacizumab; Glioblastoma; Hypoxia; Recurrence; Treatment failure; Treatment monitoring; Tumor microenvironment

Predicting mammographic density with linear ultrasound transducers - Behrens, Annika; Fasching, Peter; Schwenke, Eva; Gaß, Paul; Häberle, Lothar; Heindl, Felix; Heusinger, Katharina; Lotz, Laura; Lubrich, Hannah; Preuß, Caroline; Schneider, Michael; Schulz-Wendtland, Rüdiger; et al. (European Journal of Medical Research, 2023)
Background: High mammographic density (MD) is a risk factor for the development of breast cancer (BC). Changes in MD are influenced by multiple factors such as age, BMI, number of full-term pregnancies and lactating periods. To learn more about MD, it is important to establish non-radiation-based, alternative examination methods to mammography such as ultrasound assessments. Methods: We analyzed data from 168 patients who underwent standard-of-care mammography and performed additional ultrasound assessment of the breast using a high-frequency (12 MHz) linear probe of the VOLUSON® 730 Expert system (GE Medical Systems Kretztechnik GmbH & Co OHG, Austria). Gray level bins were calculated from ultrasound images to characterize mammographic density. Percentage mammographic density (PMD) was predicted by gray level bins using various regression models. Results: Gray level bins and PMD correlated to a certain extent. Spearman’s ρ ranged from − 0.18 to 0.32. The random forest model turned out to be the most accurate prediction model (cross-validated R 2, 0.255). Overall, ultrasound images from the VOLUSON® 730 Expert device in this study showed limited predictive power for PMD when correlated with the corresponding mammograms. Conclusions: In our present work, no reliable prediction of PMD using ultrasound imaging could be observed. As previous studies showed a reasonable correlation, predictive power seems to be highly dependent on the device used. Identifying feasible non-radiation imaging methods of the breast and their predictive power remains an important topic and warrants further evaluation. Trial registration 325-19 B (Ethics Committee of the medical faculty at Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany).
CRIS-Team Scopus Importer:2023-10-13
Keywords: Breast cancer risk; Percent mammographic density; Ultrasound

Prediction of early metastatic disease in experimental breast cancer bone metastasis by combining PET/CT and MRI parameters to a Model-Averaged Neural Network - Ellmann, Stephan; Seyler, Lisa; Evers, Jochen; Heinen, Henrik; Bozec, Aline; Prante, Olaf; Kuwert, Torsten; Uder, Michael; Bäuerle, Tobias (Bone, 2019)
Macrometastases in bone are preceded by bone marrow invasion of disseminated tumor cells. This study combined functional imaging parameters from FDG-PET/CT and MRI in a rat model of breast cancer bone metastases to a Model-averaged Neural Network (avNNet) for the detection of early metastatic disease and prediction of future macrometastases. Metastases were induced in 28 rats by injecting MDA-MB-231 breast cancer cells into the right superficial epigastric artery, resulting in the growth of osseous metastases in the right hind leg of the animals. All animals received FDG-PET/CT and MRI at days 0, 10, 20 and 30 after tumor cell injection. In total, 18/28 rats presented with metastases at days 20 or 30 (64.3%). None of the animals featured morphologic bone lesions during imaging at day 10, and the imaging parameters acquired at day 10 did not differ significantly between animals with metastases at or after day 20 and those without (all p > 0.3). The avNNet trained with the imaging parameters acquired at day 10, however, achieved an accuracy of 85.7% (95% CI 67.3-96.0%) in predicting future macrometastatic disease (ROCAUC 0.90; 95% CI 0.76-1.00), and significantly outperformed the predictive capacities of all single parameters (all p <= 0.02). The integration of functional FDG-PET/CT and MRI parameters into an avNNet can thus be used to predict macrometastatic disease with high accuracy, and their combination might serve as a surrogate marker for bone marrow invasion as an early metastatic process that is commonly missed during conventional staging examinations.
CRIS-Team WoS Importer:2019-02-27

Prediction of Hearing Preservation in Vestibular Schwannoma Surgery According to Tumor Size and Anatomic Extension - Bozhkov, Yavor; Shawarba, Julia; Feulner, Julian; Winter, Fabian; Rampp, Stefan; Hoppe, Ulrich; Dörfler, Arnd; Iro, Heinrich; Buchfelder, Michael; Rössler, Karl (Otolaryngology-Head and Neck Surgery, 2021)
Objective: Vestibular schwannoma (VS) surgery is feasible for various tumor sizes that are inappropriate for wait and scan or radiosurgery. The predictive value of 2 grading systems was investigated for postoperative hearing preservation (HP) in a large series. Study Design: Retrospective analysis. Setting: Neurosurgical patient database of the University of Erlangen was queried between 2014 and 2017. Methods: Retrospective single-center analysis on 138 VSs operated on via a retrosigmoidal approach. The mean tumor size was 20.4 mm (SD, 7.6 mm) with fundal infiltration in 67.4%. The overall resection rate was 93.5%. Tumors were classified preoperatively by the 3-tier Erlangen grading system depending on size or the anatomically based 4-tier Koos grading system. Results: Preoperative hearing preservation was found in 70.3% of patients and was significantly correlated to tumor size (P =.001). For Erlangen grading, a mean postoperative serviceable hearing preservation rate of 32% was achieved: 83.3% for tumors <12 mm, 30.3% for tumors between 12 and 25 mm, and 5.3% for tumors >25 mm. In contrast, according to Koos grading, postoperative serviceable hearing preservation was 100% for grade 1 tumors (meatal), 35.6% for grade 2 (cisternal), 23.1% for grade 3 (brainstem contact), and 21.7% for grade 4 (brainstem compression). Of the total cohort, 86% had normal or nearly normal postoperative facial function (House-Brackmann grades 1 and 2). Conclusion: Surgery on small VSs can achieve excellent hearing preservation. Different grading has a significant influence on and correlates with postoperative hearing preservation. Tumor size seems more important than anatomic relationship.
CRIS-Team Scopus Importer:2021-06-04
Keywords: Erlangen vestibula schwannoma grading; grading systems; hearing preservation; Koos vestibular schwannoma grading; vestibular schwannoma surgery

Prediction of medial tibiofemoral compartment joint space loss progression using volumetric cartilage measurements: Data from the FNIH OA biomarkers consortium - Hafezi-Nejad, Nima; Guermazi, Ali; Roemer, Frank; Hunter, David J.; Dam, Erik B.; Zikria, Bashir; Kwoh, C. Kent; Demehri, Shadpour (European Radiology, 2017)
Investigating the association between baseline cartilage volume measurements (and initial 24th month volume loss) with medial compartment Joint-Space-Loss (JSL) progression (>0.7 mm) during 24-48th months of study.Case and control cohorts (Biomarkers Consortium subset from the Osteoarthritis Initiative (OAI)) were defined as participants with (n=297) and without (n=303) medial JSL progression (during 24-48th months). Cartilage volume measurements (baseline and 24th month loss) were obtained at five knee plates (medial-tibial, lateral-tibial, medial-femoral, lateral-femoral and patellar), and standardized values were analysed. Multivariate logistic regression was used with adjustment for known confounders. Artificial-Neural-Network analysis was conducted by Multi-Layer-Perceptrons (MLPs) including baseline determinants, and baseline (1) and interval changes (2) in cartilage volumes.Larger baseline lateral-femoral cartilage volume was predictive of medial JSL (OR: 1.29 (1.01-1.64)). Greater initial 24th month lateral-femoral cartilage volume-loss (OR: 0.48 (0.27-0.84)) had protective effect on medial JSL during 24-48th months of study. Baseline and interval changes in lateral-femoral cartilage volume, were the most important estimators for medial JSL progression (importance values: 0.191(0.177-0.204), 0.218(0.207-0.228)) in the ANN analyses.Cartilage volumes (both at baseline and their change during the initial 24 months) in the lateral femoral plate were predictive of medial JSL progression.o Baseline lateral femoral cartilage volume is directly associated with medial JSL progression. o 24-month lateral femoral cartilage loss is inversely associated with medial JSL progression. o Lateral femoral cartilage volume is most important in association with medial JSL progression.
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Prediction of Response to Certolizumab-Pegol in Rheumatoid Arthritis By Functional MRI of the Brain - an Interim Analysis of an Ongoing Investigator Initiated Phase III Trial - Schenker, Hannah; Heß, Andreas; Konerth, Laura; Sergeeva, Marina; Prade, Jutta; Kleyer, Arnd; Reiser, Michaela; Hueber, Axel; Englbrecht, Matthias; Feist, Eugen; Voll, Reinhard; Bannert, Bettina; et al. (2017)
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Prediction of response to Certolizumab-Pegol in rheumatoid arthritis (PreCePRA) by functional MRI of the brain – Study protocol for a randomized double-blind controlled study - Schenker, Hannah; Tascilar, Koray; Konerth, Laura; Sergeeva, Marina; Prade, Jutta; Strobelt, Sandra; Kleyer, Arnd; Simon, David; Mendez, L.; Hagen, Melanie; Schönau, V.; Hueber, A.; et al. (Contemporary Clinical Trials Communications, 2021)
Background: Tumor necrosis factor inhibitors (TNFi) signify a major advance in the treatment of rheumatoid arthritis (RA). However, treatment success initially remains uncertain as approximately half of the patients do not respond adequately to TNFi. Thus, an unmet need exists to better predict therapeutic outcome of biologicals. Objectives: We investigated whether brain activity associated with arthritis measured by functional magnetic resonance imaging (fMRI) of the brain can serve as a predictor of response to TNFi in RA patients. Methods: PreCePRA is a multi-center, randomized, double-blind, placebo-controlled fMRI trial on patients with RA [1] [2]. Active RA patients failing csDMARDs therapy with a DAS28 > 3.2 and at least three tender and/or swollen joints underwent a brain BOLD (blood-oxygen-level dependent) fMRI scan upon joint compression at screening. Patients were then randomized into a 12-week double-blinded treatment phase with 200 mg Certolizumab Pegol (CZP) every two weeks (arm 1: fMRI BOLD signal activated volume > 2000 voxel, i.e. 2 cm3; arm 2: fMRI BOLD signal activated volume <2000 voxel) or placebo (arm 3). DAS28 low disease activity at 12 weeks was assigned as primary endpoint. A 12-week follow-up phase in which patients were switched from the placebo to the treatment arm followed the blinded phase. fMRI was carried out at screening as well as after 12 and 24 weeks of receiving CZP or placebo. Conclusion: We hypothesize that high-level central nervous representation of pain in patients with rheumatoid arthritis predicts response to the TNFi CZP which we further investigate in the PreCePRA trial.
CRIS-Team Scopus Importer:2021-06-04
Keywords: functional MRI; Neuroimaging; Rheumatoid arthritis; TNF inhibition

PREDICTION OF RESPONSE TO CERTOLIZUMAB PEGOL TREATMENT BY FUNCTIONAL MRI OF THE BRAIN: AN INTERNATIONAL, MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL (PRECEPRA) - Rech, Jürgen; Tascilar, K.; Schenker, Hannah; Sergeeva, Marina; Selvakumar, Mageshwar; Konerth, Laura; Prade, Jutta; Strobelt, Sandra; Hagen, Melanie; Schonau, V.; Valor, L.; Hueber, A.; et al. (ANNALS OF THE RHEUMATIC DISEASES, 2020)
CRIS-Team WoS Importer:2020-08-21

Predictive Validity of Radiographic Trabecular Bone Texture in Knee Osteoarthritis: The Osteoarthritis Research Society International/Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium - Kraus, Virginia Byers; Collins, Jamie E.; Charles, H. Cecil; Pieper, Carl F.; Whitley, Lawrence; Losina, Elena; Nevitt, Michael; Hoffmann, Steve; Roemer, Frank; Guermazi, Ali; Hunter, David J. (Arthritis and Rheumatology, 2018)
OBJECTIVE: To evaluate radiographic subchondral trabecular bone texture (TBT) as a predictor of clinically relevant osteoarthritis (OA) progression (combination of symptom and structural worsening). METHODS: The Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium undertook a study of progressive knee OA cases (n = 194 knees with both radiographic and pain progression over 24-48 months) and comparators (n = 406 OA knees not meeting the case definition). TBT parameters were extracted from a medial subchondral tibial region of interest by fractal signature analysis of radiographs using validated semiautomated software. Baseline TBT and time-integrated values over 12 and 24 months were evaluated for association with case status and separately with radiographic and pain progression status, adjusted for age, sex, body mass index, race, baseline Kellgren/Lawrence grade, baseline joint space width, Western Ontario and McMaster Universities Osteoarthritis Index pain score, and pain medication use. C statistics were generated from receiver operating characteristic curves. RESULTS: Relative to comparators, cases were characterized by thinner vertical and thicker horizontal trabeculae. The summed composite of 3 TBT parameters at baseline and over 12 and 24 months best predicted case status (odds ratios 1.24-1.43). The C statistic for predicting case status using the TBT composite score (0.633-0.649) was improved modestly but statistically significantly over the use of covariates alone (0.608). One TBT parameter, reflecting thickened horizontal trabeculae in cases, at baseline and over 12 and 24 months, predicted risk of any progression (radiographic and/or pain progression). CONCLUSION: Although associations are modest, TBT could be an attractive means of enriching OA trials for progressors since it can be generated from screening knee radiographs already standard in knee OA clinical trials.
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Predictive Value of Multiparametric MRI for Response to Single-Cycle Induction Chemo-Immunotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma - Hellwig, Konstantin; Ellmann, Stephan; Eckstein, Markus; Wiesmüller, Marco; Rutzner, Sandra; Semrau, Sabine; Frey, Benjamin; Gaipl, Udo; Hartmann, Arndt; Iro, Heinrich; Fietkau, Rainer; Uder, Michael; et al. (Frontiers in Oncology, 2021)
Objectives
CRIS-Team WoS Importer:2021-11-19

Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy - Tomita, Hayato; Detmar, Klaus; Manava, Panagiota; Nakajima, Yasuo; Lell, Michael; Adamus, Ralf (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2020)
Purpose To determine the predictive value of 3-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction to evaluate the short-term effect of therapy for facial palsy. Materials and Methods We included 97 patients with idiopathic facial palsy (52 male, 45 female; aged 50.7±19.4 years) who underwent MR imaging with a contrast agent after starting therapy. The mean interval between onset and therapy was 1.55±1.69 days, between therapy and MR imaging was 3.19±2.78 days, and between MR imaging and assessment of the therapeutic effect was 3.50±0.71 days. The degree of therapeutic effect was determined using a 4-grade scale based on the House-Brackmann scale for grading facial nerve function. Two radiologists reviewed VIBE with pre- and postcontrast subtraction using the 4-point scale. We evaluated the diagnostic performance and compared the degree of therapeutic effect and enhancement of facial nerves that were divided into 5 segments bilaterally. Results We identified 98 facial palsy initially and significant enhancement in 55 facial nerves after the start of therapy and residual palsy in 87. Sensitivity for all facial palsy was 62.0%, specificity was 90.9%, positive predictive value was 98.2%, negative predictive value was 23.3%, and accuracy was 65.3%. Eleven patients recovered completely, 1 showed significant enhancement, and the remaining 10 did not show significant enhancement of the facial nerve. Conclusion VIBE has a potential to predict the prognostic outcome and assess facial palsy after the start of therapy. Key points: Three-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction can be useful to predict residual facial palsy after initial therapy. Strong enhancement of the facial nerve on VIBE using subtraction was associated with residual facial palsy after the start of therapy. Patients with a favorable prognosis did not show strong enhancement. Citation Format Tomita H, Detmar K, Nakajima Y etal. Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy. Fortschr Röntgenstr 2020; 192: 1183-1189
CRIS-Team Scopus Importer:2020-12-04
Keywords: cerebral palsy; contrast agents; MR-imaging

Predictors for occlusion of cerebral AVMs following radiation therapy : Radiation dose and prior embolization, but not Spetzler-Martin grade - Knippen, Stefan; Putz, Florian; Semrau, Sabine; Lambrecht, Ulrike; Knippen, Arzu; Buchfelder, Michael; Schlaffer, Sven-Martin; Struffert, Tobias; Fietkau, Rainer (Strahlentherapie und Onkologie, 2017)
BACKGROUND: Intracranial arteriovenous malformations (AVMs) may show a harmful development. AVMs are treated by surgery, embolization, or radiation therapy. OBJECTIVE: This study investigated obliteration rates and side effects in patients with AVMs treated by radiation therapy. METHODS: A total of 40 cases treated between 2005 and 2013 were analyzed. Single-dose stereotactic radiosurgery (SRS) was received by 13 patients and 27 received hypofractionated stereotactic radiation therapy (HSRT). In 20 patients, endovascular embolization had been performed prior to irradiation and 24 patients (60 %) had a history of previous intracranial hemorrhage. RESULTS: Treatment resulted in complete obliteration (CO) in 23/40 cases and partial obliteration in 8/40. CO was achieved in 85 % of patients receiving SRS compared to 44 % of those receiving HSRT. In the HSRT group, a first indication of an influence of AVM volume on obliteration rate was found. Equivalent 2 Gy fraction doses (EQD2) >70 Gy showed an obliteration rate of 50 %. Prior embolization was significantly associated with a higher portion of CO (p = 0.032). Median latency period (24.2 vs. 26 months) until CO was similar in both groups (SRS vs. HSRT). The rate of intracranial hemorrhage in patients with no prior bleeding events was 0 %. CONCLUSION: Excellent obliteration rates were achieved by SRS. Consistent with the literature, this data analysis suggests that the results of HSRT are volume-dependent. Furthermore, regimens with EQD2 doses >70 Gy appear more likely to achieve obliteration than schemes with lower doses. The findings indicate that radiation therapy does not increase the risk of bleeding. Prior embolization may have a good prognostic impact.
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PREDICTORS OF LONGITUDINAL MRI-BASED CARTILAGE THICKNESS CHANGE IN THE OBSERVATIONAL MULTICENTER APPROACH COHORT - Maschek, S.; Roemer, Frank; Marijnissen, A. C.; Jansen, M.; Wisser, A.; Lafeber, F.; Lalande, A.; Weinans, H. H.; Blanco, F. J.; Berenbaum, F.; Van De Stadt, L. A.; Kloppenburg, M.; et al. (OSTEOARTHRITIS AND CARTILAGE, 2022)
CRIS-Team WoS Importer:2022-04-22

Preliminary validation of 2 magnetic resonance image scoring systems for osteoarthritis of the hip according to the OMERACT filter - Maksymowych, Walter P.; Cibere, Jolanda; Loeuille, Damien; Weber, Ulrich; Zubler, Veronika; Roemer, Frank; Jaremko, Jacob L.; Sayre, Eric C.; Lambert, Robert G. W. (Journal of Rheumatology, 2014)
Development of a validated magnetic resonance image (MRI) scoring system is essential in hip OA because radiographs are insensitive to change. We assessed the feasibility and reliability of 2 previously developed scoring methods: (1) the Hip Inflammation MRI Scoring System (HIMRISS) and (2) the Hip Osteoarthritis MRI Scoring System (HOAMS).Six readers (3 radiologists, 3 rheumatologists) participated in 2 reading exercises. In Reading Exercise 1, MRI of the hip of 20 subjects were read at a single time point followed by further standardization of methodology. In Reading Exercise 2, MRI of the hip of 18 subjects from a randomized controlled trial, assessed at 2 timepoints, and 27 subjects from a cross-sectional study were read for HIMRISS and HOAMS bone marrow lesions (BML) and synovitis. Reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics.Both methods were considered feasible. For Reading 1, HIMRISS ICC were 0.52, 0.61, 0.70, and 0.58 for femoral BML, acetabular BML, effusion, and total scores, respectively; and for HOAMS, summed BML and synovitis ICC were 0.52 and 0.46, respectively. For Reading 2, HIMRISS and HOAMS ICC for BML and synovitis-effusion improved substantially. Interobserver reliability for change scores was 0.81 and 0.71 for HIMRISS femoral and HOAMS summed BML, respectively. Responsiveness and discrimination was moderate to high for synovitis-effusion. Significant associations were noted between BML or synovitis scores and Western Ontario and McMaster Universities Osteoarthritis Index pain scores for baseline values (p <= 0.001).The BML and synovitis-effusion components of both HIMRISS and HOAMS scoring systems are feasible and reliable, and should be validated further.
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Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases - Glöckler, Martin; Halbfass, Julia; Koch, Andreas; Dittrich, Sven; Achenbach, Stephan; Rueffer, Andre; Ihlenburg, Katharina Susanne; Cesnjevar, Robert; May, Matthias; Uder, Michael; Rompel, Oliver (European Journal of Cardio-Thoracic Surgery, 2014)
To evaluate the feasibility, image quality and impact of 3D imaging in low-dose high-pitch dual-source computed tomography (DSCT) to assess arbitrary anatomical malformations of the aortic arch in children <1 year of age with congenital heart disease (CHD).Between January 2010 and May 2013, DSCT was performed to assess the aortic arch anatomy in a total of 62 consecutive patients with CHD (aged 0-348 days). DSCT was used whenever conventional echocardiography was not sufficient to display the complex anatomy entirely. Image data acquisition was realized within a single cardiac cycle using prospective ECG triggering. 3D reconstruction for surgical planning was performed. Image quality was assessed retrospectively, using a 4-point scale from '1 = no artefacts' to '4 = uninterpretable'. The accuracy and impact of the 3D reconstructions was compared with intraoperative findings using a 5-point scale (from '1 = essential' to '5 = misleading'). Administered radiation exposure was evaluated.Imaging was successful in all patients, image quality was rated 1.34 on the 4-point scale and the impact of the 3D reconstructions for surgical planning was 2.05 on the 5-point scale. Mean dose-length product was 6.8 ± 2.6 mGy cm, and the effective dose was 0.45 ± 0.13 mSv (0.21-0.74).DSCT is a fast and appropriate imaging modality in the preoperative assessment of the aortic arch for surgical planning in CHD.
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Pre-radiographic osteoarthritic changes are highly prevalent in the medial patella and medial posterior femur in older persons: Framingham OA study - Hayashi, D.; Felson, D. T.; Niu, J.; Hunter, D. J.; Roemer, Frank; Aliabadi, P.; Guermazi, A. (Osteoarthritis and Cartilage, 2014)
To determine which subregions of the knee joint have a high prevalence of pre-radiographic osteoarthritic changes, i.e., cartilage damage and osteophytes that can only be detected by magnetic resonance imaging (MRI), in radiographically normal knees.Institutional Review Board approval and written informed consent from all participants was obtained. Data was collected from a community cohort in Framingham, MA, involving people aged 50-79. Participants underwent weight-bearing posteroanterior and lateral knee radiography with the fixed-flexion protocol, and 1.5 T MRI. Knees without radiographic osteoarthritis (Kellgren Lawrence grade 0 for the tibiofemoral joint and absence of any osteophytes or joint space narrowing in the patellofemoral joint) were included. The knee joint was divided into 14 subregions for cartilage and 16 subregions for osteophytes, and prevalence and severity of cartilage damage (grade 0-6) and osteophytes (grade 0-7) were semiquantitatively assessed using the Whole Organ Magnetic Resonance Imaging Score (WORMS).The mean age of 696 participants was 62.3 ± 8.4 years, and the mean body mass index was 27.9 ± 5.1 kg/m2. Women comprised 55.2% of the study sample (384/696). Prevalence of cartilage damage (grade >=2) was 47.7% (332/696) in the medial patellar and 29.9% (208/696) in patellar lateral (PL) subregions, and 24.0% (167/696) in femoral medial anterior (FMA) and 26.5% (184/696) in femoral medial central (FMC) subregions. Prevalence of osteophytes (grade >=2) was highest at 60.8% (423/696) in the medial femoral posterior subregion, followed by 34.0% (237/696) in PL and 24.6% (171/696) in patellar medial (PM) subregions. For all other subregions, prevalence of these lesions was lower than the aforementioned percentages.MRI-detected cartilage damage and osteophytes are highly prevalent in the medial patellofemoral and medial posterior tibiofemoral joints in radiographically normal knees in persons aged 50-79.
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Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage - Spuergel, Maximilian I.; Kuramatsu, Joji; Gerner, Stefan; Sembill, Jochen; Hartwich, Julius; Giede-Jeppe, Antje; Madzar, Dominik; Beuscher, Vanessa D.; Lücking, Hannes; Struffert, Tobias; Schwab, Stefan; Huttner, Hagen; et al. (Cerebrovascular Diseases, 2017)
Data on clinical characteristics and outcome of patients with intracerebral hemorrhage (ICH) and concomitant systemic cancer disease are very limited.Nine hundred and seventy three consecutive primary ICH patients were analyzed using our prospective institutional registry over a period of 9 years (2006-2014). We compared clinical and radiological parameters as well as outcome - scored using the modified Rankin Scale (mRS) and analyzed in a dichotomized fashion as favorable outcome (mRS = 0-3) and unfavorable outcome (mRS = 4-6) - of ICH patients with and without cancer. Relevant imbalances in baseline clinical and radiological characteristics were adjusted using propensity score (PS) matching.Prevalence of systemic cancer among patients with ICH was 8.5% (83/973). ICH patients with cancer were older (77 [70-82] vs. 72 [63-80] years; p = 0.002), had more often prior renal dysfunction (19/83 [22.9%] vs.107/890 [12.0%]; p = 0.005), and smaller hemorrhage volumes (10.1 [4.8-24.3] vs. 15.3 [5.4-42.9] mL; p = 0.017). After PS-matching there were no significant differences neither in mortality nor in functional outcome both at 3 months (mortality: 33/81 [40.7%] vs. 55/158 [34.8%]; p = 0.368; mRS = 0-3: 28/81 [34.6%] vs. 52/158 [32.9%]; p = 0.797) and 12 months (mortality: 39/78 [50.0%] vs. 70/150 [46.7%]; p = 0.633; mRS = 0-3: 25/78 [32.1%] vs. 53/150 [35.3%]; p = 0.620) among patients with and without concomitant systemic cancer. ICH volume tended to be highest in patients with hematooncologic malignancy and smallest in urothelial cancer.Patients with ICH and concomitant systemic cancer on average are older; however, they show smaller ICH volumes compared to patients without cancer. Yet, mortality and functional outcome is not different in ICH patients with and without cancer. Thus, the clinical history or the de novo diagnosis of concomitant malignancies in ICH patients should not lead to unjustified treatment restrictions.
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PREVALENCE AND CHARACTERISTICS OF SPONDYLOARTHRITIS ACCORDING TO ASAS CRITERIA IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE - RESULTS FROM THE SPICE COHORT - Haschka, J.; Hirschmann, S.; Kleyer, Arnd; Englbrecht, Matthias; Zimmermann, Julia; Faustini, F.; Simon, David; Figueiredo, C. P.; Muschitz, C.; Kocijan, R.; Resch, H.; Atreya, Raja; et al. (2017)
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Prevalence and influencing factors for artifact development in breast MRI-derived maximum intensity projections - Kapsner, Lorenz; Balbach, Eva; Laun, Frederik Bernd; Baumann, Lukas; Ohlmeyer, Sabine; Uder, Michael; Bickelhaupt, Sebastian; Wenkel, Evelyn (Acta Radiologica, 2023)
Background: Magnetic resonance imaging (MRI) provides high diagnostic sensitivity for breast cancer. However, MRI artifacts may impede the diagnostic assessment. This is particularly important when evaluating maximum intensity projections (MIPs), such as in abbreviated MRI (AB-MRI) protocols, because high image quality is desired as a result of fewer sequences being available to compensate for problems. Purpose: To describe the prevalence of artifacts on dynamic contrast enhanced (DCE) MRI-derived MIPs and to investigate potentially associated attributes. Material and Methods: For this institutional review board approved retrospective analysis, MIPs were generated from subtraction series and cropped to represent the left and right breasts as regions of interest. These images were labeled by three independent raters regarding the presence of MRI artifacts. MRI artifact prevalence and associations with patient characteristics and technical attributes were analyzed using descriptive statistics and generalized linear models (GLMMs). Results: The study included 2524 examinations from 1794 patients (median age 50 years), performed on 1.5 and 3.0 Tesla MRI systems. Overall inter-rater agreement was kappa = 0.54. Prevalence of significant unilateral artifacts was 29.2% (736/2524), whereas bilateral artifacts were present in 37.8% (953/2524) of all examinations. According to the GLMM, artifacts were significantly positive associated with age (odds ratio [OR] = 1.52) and magnetic field strength (OR = 1.55), whereas a negative effect could be shown for body mass index (OR = 0.95). Conclusion: MRI artifacts on DCE subtraction MIPs of the breast, as used in AB-MRI, are a relevant topic. Our results show that, besides the magnetic field strength, further associated attributes are patient age and body mass index, which can provide possible targets for artifact reduction.
CRIS-Team Scopus Importer:2023-09-22
Keywords: Artifacts; breast; contrast agent; magnetic resonance imaging; prevalence

Prevalence of monosodium urate deposits in a population of rheumatoid arthritis patients with hyperuricemia - Petsch, Christina; Araujo, Elizabeth G.; Englbrecht, Matthias; Bayat, Sara; Hueber, Axel; Lell, Michael; Schett, Georg; Manger, Bernhard; Rech, Jürgen; Cavallaro, Alexander Josef (Seminars in Arthritis and Rheumatism, 2015)
To investigate the prevalence of monosodium urate (MSU) crystal deposits, indicative for gout, in a population of rheumatoid arthritis (RA) patients with concomitant hyperuricemia and to analyze the clinical and disease-specific characteristics of RA patients who exhibit MSU crystal deposits.Overall, 100 consecutive patients with the diagnosis of RA and a serum urate level above 6mg/dl underwent dual energy computed tomography (DECT) of both feet and hands to search for MSU crystals in a prospective study between October 2011 and July 2013. Presence and extent of MSU crystal deposits on DECT was assessed by automated volume measurement. Demographic and disease-specific characteristics were recorded and included into two logistic regression models to test for the factors associated with MSU crystal deposits in RA.Hyperuricemic RA patients were mostly male (55%), over 60 years of age (63 ± 11 years), had established disease (8.7 ± 10.5 years) and a mean disease activity score 28 (DAS 28) of 3.2. In total, 20 out of 100 patients displayed MSU crystal deposits in DECT. Interestingly, the majority (70%) of the RA patients positive for MSU crystal deposits were seronegative RA patients. Hence, every third seronegative RA patient had MSU crystal deposits. According to logistic regression model analysis, seronegative status correlated positively with presence of urate deposits (p = 0.019).These data show that a considerable number of RA patients display periarticular MSU crystal deposits. Seronegative patients were shown to be predominantly affected with every third patient being positive for urate deposits.
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Prevalence of MRI-Detected Ankle Injuries in Athletes in the Rio de Janeiro 2016 Summer Olympics. - Heiß, Rafael; Guermazi, Ali; Jarraya, Mohamed; Engebretsen, Lars; Hotfiel, Thilo; Parva, Pedram; Roemer, Frank (Academic Radiology, 2019)
OBJECTIVE: To describe the prevalence, severity, and location of ankle injuries as assessed on magnetic resonance imaging (MRI) in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games. METHODS: We analyzed all ankle MRIs that were acquired for suspected injury as reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic. Images were interpreted retrospectively according to standardized criteria. RESULTS: A total of 11,274 athletes participated in the Games, of which 89 (8.8%) were referred for an ankle MRI. Eighty-eight of the 89 (99%) had at least 1 abnormal finding, and some had as many as 27, for an average of 6.2 abnormalities per examination. Around one-fifth of all abnormal findings were considered pre-existing (21%) and 79% were assumed to be the result of an acute or subacute injury. The highest proportion of acute/subacute injuries per athlete occurred in ball sports (7.0 injuries per examination) and in the age group >30. Most pre-existing findings per athlete were identified in the group of others (no track and field or ball sports athletes) with 2.5 findings per examination and respectively in the age group >30 (1.7). CONCLUSION: Our study demonstrated a high prevalence of acute and subacute, but also pre-existing injuries in Olympic athletes undergoing ankle MRI. Tendon injuries were the most common acute injuries, found mainly in ball sports athletes. Most pre-existing ankle injuries were identified at the ligaments.
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PRG3 induces Ras-dependent oncogenic cooperation in gliomas - Fan, Zheng; Bittermann-Rummel, Philipp; Yakubov, Eduard; Chen, Daishi; Broggini, Thomas; Sehm, Tina; Hatipoglu Majernik, Gökce; Hock, Stefan; Schwarz, Marc; Engelhorn, Tobias; Dörfler, Arnd; Buchfelder, Michael; et al. (Oncotarget, 2016)
Malignant gliomas are one of the most devastating cancers in humans. One characteristic hallmark of malignant gliomas is their cellular heterogeneity with frequent genetic lesions and disturbed gene expression levels conferring selective growth advantage. Here, we report on the neuronal-associated growth promoting gene PRG3 executing oncogenic cooperation in gliomas. We have identified perturbed PRG3 levels in human malignant brain tumors displaying either elevated or down-regulated PRG3 levels compared to non-transformed specimens. Further, imbalanced PRG3 levels in gliomas foster Ras-driven oncogenic amplification with increased proliferation and cell migration although angiogenesis was unaffected. Hence, PRG3 interacts with RasGEF1 (RasGRF1/CDC25), undergoes Ras-induced challenges, whereas deletion of the C-terminal domain of PRG3 (PRG3ΔCT) inhibits Ras. Moreover PRG3 silencing makes gliomas resistant to Ras inhibition. In vivo disequilibrated PRG3 gliomas show aggravated proliferation, invasion, and deteriorate clinical outcome. Thus, our data show that the interference with PRG3 homeostasis amplifies oncogenic properties and foster the malignancy potential in gliomas.
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Primary renal sarcomas: imaging features and discrimination from non-sarcoma renal tumors - Uhlig, Johannes; Uhlig, Annemarie; Bachanek, Sophie; Onur, Mehmet Ruhi; Kinner, Sonja; Geisel, Dominik; Kohler, Michael; Preibsch, Heike; Puesken, Michael; Schramm, Dominik; May, Matthias; De Visschere, Pieter; et al. (European Radiology, 2021)
Objectives To assess imaging features of primary renal sarcomas in order to better discriminate them from non-sarcoma renal tumors. Methods Adult patients diagnosed with renal sarcomas from 1995 to 2018 were included from 11 European tertiary referral centers (Germany, Belgium, Turkey). Renal sarcomas were 1:4 compared to patients with non-sarcoma renal tumors. CT/MRI findings were assessed using 21 predefined imaging features. A random forest model was trained to predict "renal sarcoma vs. non-sarcoma renal tumors" based on demographics and imaging features. Results n = 34 renal sarcomas were included and compared to n = 136 non-sarcoma renal tumors. Renal sarcomas manifested in younger patients (median 55 vs. 67 years, p < 0.01) and were more complex (high RENAL score complexity 79.4% vs. 25.7%, p < 0.01). Renal sarcomas were larger (median diameter 108 vs. 43 mm, p < 0.01) with irregular shape and ill-defined margins, and more frequently demonstrated invasion of the renal vein or inferior vena cava, tumor necrosis, direct invasion of adjacent organs, and contact to renal artery or vein, compared to non-sarcoma renal tumors (p < 0.05, each). The random forest algorithm yielded a median AUC = 93.8% to predict renal sarcoma histology, with sensitivity, specificity, and positive predictive value of 90.4%, 76.5%, and 93.9%, respectively. Tumor diameter and RENAL score were the most relevant imaging features for renal sarcoma identification. Conclusion Renal sarcomas are rare tumors commonly manifesting as large masses in young patients. A random forest model using demographics and imaging features shows good diagnostic accuracy for discrimination of renal sarcomas from non-sarcoma renal tumors, which might aid in clinical decision-making.
CRIS-Team WoS Importer:2021-08-13

Principles of T2 *-weighted dynamic susceptibility contrast MRI technique in brain tumor imaging - Shiroishi, Mark S.; Castellazzi, Gloria; Boxerman, Jerrold L.; D'Amore, Francesco; Essig, Marco; Nguyen, Thanh B.; Provenzale, James M.; Enterline, David S.; Anzalone, Nicoletta; Dörfler, Arnd; Rovira, Alex; Wintermark, Max; et al. (Journal of Magnetic Resonance Imaging, 2015)
Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is used to track the first pass of an exogenous, paramagnetic, nondiffusible contrast agent through brain tissue, and has emerged as a powerful tool in the characterization of brain tumor hemodynamics. DSC-MRI parameters can be helpful in many aspects, including tumor grading, prediction of treatment response, likelihood of malignant transformation, discrimination between tumor recurrence and radiation necrosis, and differentiation between true early progression and pseudoprogression. This review aims to provide a conceptual overview of the underlying principles of DSC-MRI of the brain for clinical neuroradiologists, scientists, or students wishing to improve their understanding of the technical aspects, pitfalls, and controversies of DSC perfusion MRI of the brain. Future consensus on image acquisition parameters and postprocessing of DSC-MRI will most likely allow this technique to be evaluated and used in high-quality multicenter studies and ultimately help guide clinical care.
EVALuna2:23001

Prior-based automatic segmentation of the carotid artery lumen in TOF MRA (PASCAL) - Hutter, Jana; Hofmann, Hannes; Grimm, Robert; Greiser, Andreas; Saake, Marc; Hornegger, Joachim; Dörfler, Arnd; Schmitt, Peter (Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 2012)
In current clinical practice, examinations of the carotid artery bifurcation are commonly carried out with Computed Tomography Angiography (CTA) or contrast-enhanced Magnetic Resonance Angiography (ceMRA). Quantitative information about vessel morphology, extracted from segmentations, is promising for diagnosis of vessel pathologies. However, both above-mentioned techniques require the administration of contrast media. In contrary, non-ce MRA methods such as Time-of-Flight (TOF) provide fully non-invasive imaging without any exogenous contrast agent. The diagnostic value of TOF MRA, however, for assessment of the carotid bifurcation area can be hampered due to its susceptibility to irregular blood flow patterns. Conventional methods for lumen segmentation are very sensitive to such signal voids and produce inaccurate results. In this work, a novel, fully automatic 3D segmentation algorithm is proposed which uses prior knowledge about irregular flow patterns. The presented technique has been successfully tested on eleven volunteer datasets as well as in a patient case, offering the comparison to CTA images. The sensitivity could be increased by 29.2% to 85.6% compared to standard level set methods. The root mean squared error in diameter measurements was reduced from 4.85mm to 1.44 mm.
CRIS-Team Scopus Importer:2022-08-05

Proangiogenic effects of tumor cells on endothelial progenitor cells vary with tumor type in an in vitro and in vivo rat model. - An, Ran; Schmid, Rafael; Klausing, Anne; Robering, Jan Willem; Weber, Manuel; Bäuerle, Tobias; Detsch, Rainer; Boccaccini, Aldo R.; Horch, Raymund E.; Boos, Anja; Weigand, Annika (The FASEB Journal, 2018)
Endothelial progenitor cells (EPCs) contribute to neovascularization in tumors. However, the relationship of EPCs and tumor-induced angiogenesis still remains to be clarified. The present study aimed at investigating the influence of 4 different tumor types on angiogenic properties of EPCs in an in vitro and in vivo rat model. It could be demonstrated that in vitro proliferation, migration, and angiogenic abilities and genetic modifications of EPCs are controlled in a tumor-type-dependent manner. The proangiogenic effect of mammary carcinoma, osteosarcoma, and rhabdomyosarcoma cells was more pronounced compared to colon carcinoma cells. Coinjection of encapsulated tumor cells, especially mammary carcinoma cells, and EPCs in a rat model confirmed a contributing effect of EPCs in tumor vascularization. Cytokines secreted by tumors such as monocyte chemoattractant protein 1, macrophage inflammatory protein 2, and TNF-related apoptosis-inducing ligand play a pivotal role in the tumor cell-EPC interaction, leading to enhanced migration and angiogenesis. With the present study, we were able to decipher possible underlying mechanisms by which EPCs are stimulated by tumor cells and contribute to tumor vascularization. The present study will contribute to a better understanding of tumor-induced vascularization, thus facilitating the development of therapeutic strategies targeting tumor-EPC interactions.-An, R., Schmid, R., Klausing, A., Robering, J. W., Weber, M., Bäuerle, T., Detsch, R., Boccaccini, A. R., Horch, R. E., Boos, A. M., Weigand, A. Proangiogenic effects of tumor cells on endothelial progenitor cells vary with tumor type in an in vitro and in vivo rat model.

Probing the microscopic environment of 23 Na ions in brain tissue by MRI: On the accuracy of different sampling schemes for the determination of rapid, biexponential T2* decay at low signal-to-noise ratio - Lommen, Jonathan M.; Flassbeck, Sebastian; Behl, Nicolas G. R.; Niesporek, Sebastian; Bachert, Peter; Ladd, Mark E.; Nagel, Armin Michael (Magnetic Resonance in Medicine, 2018)
PURPOSE: To investigate and to reduce influences on the determination of the short and long apparent transverse relaxation times ( T2,s*, T2,l*) of 23 Na in vivo with respect to signal sampling. METHODS: The accuracy of T2* determination was analyzed in simulations for five different sampling schemes. The influence of noise in the parameter fit was investigated for three different models. A dedicated sampling scheme was developed for brain parenchyma by numerically optimizing the parameter estimation. This scheme was compared in vivo to linear sampling at 7T. RESULTS: For the considered sampling schemes, T2,s* / T2,l* exhibit an average bias of 3% / 4% with a variation of 25% / 15% based on simulations with previously published T2* values. The accuracy could be improved with the optimized sampling scheme by strongly averaging the earliest sample. A fitting model with constant noise floor can increase accuracy while additional fitting of a noise term is only beneficial in case of sampling until late echo time > 80 ms. T2* values in white matter were determined to be T2,s* = 5.1 ± 0.8 / 4.2 ± 0.4 ms and T2,l* = 35.7 ± 2.4 / 34.4 ± 1.5 ms using linear/optimized sampling. CONCLUSION: Voxel-wise T2* determination of 23 Na is feasible in vivo. However, sampling and fitting methods have to be chosen carefully to retrieve accurate results. Magn Reson Med 80:571-584, 2018. © 2018 International Society for Magnetic Resonance in Medicine.
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Prognostic Accuracy of CTP Summary Maps in Patients with Large Vessel Occlusive Stroke and Poor Revascularization after Mechanical Thrombectomy-Comparison of Three Automated Perfusion Software Applications - Mühlen, Iris; Borutta, Matthias; Siedler, Gabriela; Engelhorn, Tobias; Hock, Stefan; Knott, Michael; Hölter, Philip; Volbers, Bastian; Schwab, Stefan; Dörfler, Arnd (Tomography, 2022)
Background: Innovative automated perfusion software solutions offer support in the management of acute stroke by providing information about the infarct core and penumbra. While the performance of different software solutions has mainly been investigated in patients with successful recanalization, the prognostic accuracy of the hypoperfusion maps in cases of futile recanalization has hardly been validated. Methods: In 39 patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation and poor revascularization (thrombolysis in cerebral infarction (TICI) 0-2a) after mechanical thrombectomy (MT), hypoperfusion analysis was performed using three different automated perfusion software solutions (A: RAPID, B: Brainomix e-CTP, C: Syngo.via). The hypoperfusion volumes (HV) as Tmax > 6 s were compared with the final infarct volumes (FIV) on follow-up CT 36-48 h after futile recanalization. Bland-Altman analysis was applied to display the levels of agreement and to evaluate systematic differences. Based on the median hypoperfusion intensity ratio (HIR, volumetric ratio of tissue with a Tmax > 10 s and Tmax > 6 s) patients were dichotomized into high- and low-HIR groups. Subgroup analysis with favorable (<0.6) and unfavorable (>= 0.6) HIR was performed with respect to the FIV. HIR was correlated to clinical baseline and outcome parameters using Pearson's correlation. Results: Overall, there was good correlation without significant differences between the HVs and the FIVs with package A (r = 0.78, p < 0.001) being slightly superior to B and C. However, levels of agreement were very wide for all software applications in Bland-Altman analysis. In cases of large infarcts exceeding 150 mL the performance of the automated software solutions generally decreased. Subgroup analysis revealed the FIV to be generally underestimated in patients with HIR >= 0.6 (p < 0.05). In the subgroup with favorable HIR, however, there was a trend towards an overestimation of the FIV. Nevertheless, packages A and B showed good correlation between the HVs and FIVs without significant differences (p > 0.2), while only package C significantly overestimated the FIV (-54.6 +/- 56.0 mL, p = 0.001). The rate of modified Rankin Scale (mRS) 0-3 after 3 months was significantly higher in favorable vs. unfavorable HIR (42.1% vs. 13.3%, p = 0.02). Lower HIR was associated with higher Alberta Stroke Program Early CT Score (ASPECTS) at presentation and on follow-up imaging, lower risk of malignant edema, and better outcome (p < 0.05). Conclusion: Overall, the performance of the automated perfusion software solutions to predict the FIV after futile recanalization is good, with decreasing accuracy in large infarcts exceeding 150 mL. However, depending on the HIR, FIV can be significantly over- and underestimated, with Syngo showing the widest range. Our results indicate that the HIR can serve as valuable parameter for outcome predictions and facilitate the decision whether or not to perform MT in delicate cases.
CRIS-Team WoS Importer:2022-07-08

Prognostic significance of increased bone marrow microcirculation in newly diagnosed multiple myeloma: results of a prospective DCE-MRI study - Merz, Maximilian; Moehler, Thomas M.; Ritsch, Judith; Bäuerle, Tobias; Zechmann, Christian M.; Wagner, Barbara; Jauch, Anna; Hose, Dirk; Kunz, Christina; Hielscher, Thomas; Laue, Hendrik; Goldschmidt, Hartmut; et al. (European Radiology, 2015)
Aim of this prospective study was to investigate prognostic significance of increased bone marrow microcirculation as detected by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for survival and local complications in patients with multiple myeloma (MM).We performed DCE-MRI of the lumbar spine in 131 patients with newly diagnosed MM and analysed data according to the Brix model to acquire amplitude A and exchange rate constant k ep. In 61 patients a second MRI performed after therapy was evaluated to assess changes in vertebral height and identify vertebral fractures.Correlation analysis revealed significant positive association between beta2-microglobulin as well as immunoparesis with DCE-MRI parameters A and k ep. Additionally, A was negatively correlated with haemoglobin levels and k ep was positively correlated with LDH levels. Higher baseline k ep values were associated with decreased vertebral height in a second MRI (P = 0.007) and A values were associated with new vertebral fractures in the lower lumbar spine (P = 0.03 for L4). Pre-existing lytic bone lesions or remission after therapy had no impact on the occurrence of vertebral fractures. Multivariate analysis revealed that amplitude A is an independent adverse risk factor for overall survival.DCE-MRI is a non-invasive tool with significance for systemic prognosis and vertebral complications.o Qualitative parameters from DCE-MRI are correlated with established factors of disease activity o Increased marrow microcirculation might be a risk factor for loss of vertebral height and fractures o Amplitude A is an independent predictor for shortened overall survival.
EVALuna2:14502

Prognostic value of cta-derived left ventricular mass in neonates with congenital heart disease - Ellmann, Stephan; Nickel, Julie-Marie; Heiß, Rafael; El Amrani, Nouhayla; Wüst, Wolfgang; Rompel, Oliver; Rueffer, Andre; Cesnjevar, Robert; Dittrich, Sven; Uder, Michael; May, Matthias (Diagnostics, 2021)
For therapeutic decisions regarding uni-or biventricular surgical repair in congenital heart disease (CHD), left ventricular mass (LVM) is an important factor. The aim of this retrospective study was to determine the LVM of infants with CHD in thoracic computed tomography angiographies (CTAs) and to evaluate its usefulness as a prognostic parameter, with special attention paid to hypoplastic left heart (HLH) patients. Manual segmentation of the left ventricular endo-and epicardial volumes was performed in CTAs of 132 infants. LVMs were determined from these volumes and normalized to body surface area. LVMs of patients with different types of CHD were compared to each other using analyses of variances (ANOVA). An LVM cutoff for discrimination between uni-and biventricular repair was determined using receiver operating characteristics. Survival rates were calculated using Kaplan–Meier statistics. Patients with a clinical diagnosis of an HLH had significantly lower mean LVM (21.88 g/m2) compared to patients without applicable disease (50.22 g/m2; p < 0.0001) and compared to other CHDs, including persistent truncus arteriosus, left ventricular outflow tract obstruction, transposition of the great arteries, pulmonary artery stenosis or atresia, and double-outlet right ventricle (all, p < 0.05). The LVM cutoff for uni-vs. biventricular surgery was 33.9 g/m2 (sensitivity: 82.3%; specificity: 73.7%; PPV: 94.9%). In a subanalysis of HLH patients, a sensitivity of 50.0%, specificity of 100%, PPV of 100%, and NPV of 83.3% was determined. Patient survival was not significantly different between the surgical approaches or between patients with LVM above or below the cutoff. LVM can be measured in chest CTA of newborns with CHD and can be used as a prognostic factor.
CRIS-Team Scopus Importer:2021-07-30
Keywords: Cardiac computed tomography; Computed tomography angiography; Congenital heart disease; Heart imaging; Heart surgery; Hypoplastic left heart

Prognostic Value of "Prepectoral Edema" in MR-mammography - Kaiser, Clemens G.; Herold, Michael; Krammer, Julia; Baltzer, Pascal; Gajda, Mieczyslaw; Camara, Oumar; Schoenberg, Stefan; Kaiser, Werner A.; Dietzel, Matthias (Anticancer Research, 2017)
BACKGROUND/AIM: Previous studies have indicated a highly significant correlation between invasive tumors and accompanying prepectoral edema (PE) in MR-mammography (MRM). The aim of the present study was to identify prognostic factors associated with PE as a diagnostic sign. MATERIALS AND METHODS: A total of 1,109 consecutive MRM exams were included in this study. Exclusion criteria were previous operation, biopsy, intervention, chemotherapy, hormone replacement therapy (HRT) or previous mastitis. One hundred and sixty-two patients with 180 lesions were evaluated and histologically correlated. Diagnostic evaluations were performed by four experienced radiologists in consensus. RESULTS: One hundred and eighty lesions included 104 malignant lesions (93 invasive and 11 non-invasive) and 76 benign lesions. PE was detected significantly more frequently in presence of lymphangiosis carcinomatosa ((53.8%; 14/26) vs. (9.8%; 4/41)) (p<0,000). PE significantly correlates with positive axillary nodal status ((19.4% (12/62) vs. 44.4% (12/27)) (p=0.020), as well as pathologic enhancement of the pectoral muscle (5.4% (5/93) vs. 22.7% (20/88)) (p=0,015). PE significantly correlates with higher tumor grading (G3) (33.9% vs. 13.9%) (p<0.05). There was no significant difference in a positive vs. negative estrogen (p=0.681) and progesterone (p=0.751) and/or human epidermal growth factor receptor-2 (HER-2) (p=0.726) receptor status accompanied by PE. CONCLUSION: The presence of PE may be a strong prognostic indicator for lymphatic spread and the cancerous infiltration of lymph nodes. It is also associated with the infiltration of the pectoral muscle, as well as high tumor grading. There is no correlation between prepectoral edema and positive tumor receptor status.
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Progression of cartilage damage and meniscal pathology over 30 months is associated with an increase in radiographic tibiofemoral joint space narrowing in persons with knee OA–the MOST study - Crema, M. D.; Nevitt, M. C.; Guermazi, A.; Felson, D. T.; Wang, K.; Lynch, J. A.; Marra, M. D.; Torner, J.; Lewis, C. E.; Roemer, Frank (Osteoarthritis and Cartilage, 2014)
To determine the association of MRI-assessed worsening of tibiofemoral cartilage damage, meniscal damage, meniscal extrusion, separately and together, with progression of radiographic joint space narrowing (JSN).The Multicenter Osteoarthitis Study (MOST) Study is a cohort study of subjects with or at risk for knee osteoarthritis (OA). Knees with radiographic OA Kellgren-Lawrence grade 2 at baseline and with baseline and 30-month 1.0 T MRIs were selected for reading using the WORMS system for cartilage damage, meniscal damage, and meniscal extrusion. The association of worsening of cartilage damage, meniscal damage, and/or meniscal extrusion with increases in the JSN was performed using logistic regression.A total of 276 knees (one per subject) were included (women 68.5%, mean age 62.9 ± 7.8, mean body mass index (BMI) 30.2 ± 5.0). Worsening of each MRI feature was associated with any increase in JSN (P < 0.01). Worsening of cartilage damage was more frequently observed than worsening of meniscal damage and extrusion, and was significantly associated with both slow and fast progression of JSN. An increasing risk of JSN worsening was associated with increasing number of worsening MRI features (P for trend < 0.0001).Worsening of tibiofemoral cartilage damage, meniscal damage, and meniscal extrusion are independent predictors of JSN progression in the same compartment. Worsening of cartilage damage is more frequently observed in JSN when compared to meniscal worsening. A strong cumulative effect on JSN progression is observed for worsening of more than one MRI feature.
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Projection image-to-image translation in hybrid x-ray/MR imaging - Stimpel, Bernhard; Syben-Leisner, Christopher; Würfl, Tobias; Breininger, Katharina; Lommen, Jonathan; Dörfler, Arnd; Maier, Andreas (Progress in Biomedical Optics and Imaging - Proceedings of SPIE, 2019)
The potential benefit of hybrid X-ray and MR imaging in the interventional environment is large due to the combination of fast imaging with high contrast variety. However, a vast amount of existing image enhancement methods requires the image information of both modalities to be present in the same domain. To unlock this potential, we present a solution to image-to-image translation from MR projections to corresponding x-ray projection images. The approach is based on a state-of-the-art image generator network that is modified to fit the specific application. Furthermore, we propose the inclusion of a gradient map in the loss function to allow the network to emphasize high-frequency details in image generation. Our approach is capable of creating x-ray projection images with natural appearance. Additionally, our extensions show clear improvement compared to the baseline method.
CRIS-Team Scopus Importer:2019-07-12

Projection-to-Projection Translation for Hybrid X-ray and Magnetic Resonance Imaging - Stimpel, Bernhard; Syben-Leisner, Christopher; Würfl, Tobias; Breininger, Katharina; Hölter, Philip; Dörfler, Arnd; Maier, Andreas (Scientific Reports, 2019)
Hybrid X-ray and magnetic resonance (MR) imaging promises large potential in interventional medical imaging applications due to the broad variety of contrast of MRI combined with fast imaging of X-ray-based modalities. To fully utilize the potential of the vast amount of existing image enhancement techniques, the corresponding information from both modalities must be present in the same domain. For image-guided interventional procedures, X-ray fluoroscopy has proven to be the modality of choice. Synthesizing one modality from another in this case is an ill-posed problem due to ambiguous signal and overlapping structures in projective geometry. To take on these challenges, we present a learning-based solution to MR to X-ray projection-to-projection translation. We propose an image generator network that focuses on high representation capacity in higher resolution layers to allow for accurate synthesis of fine details in the projection images. Additionally, a weighting scheme in the loss computation that favors high-frequency structures is proposed to focus on the important details and contours in projection imaging. The proposed extensions prove valuable in generating X-ray projection images with natural appearance. Our approach achieves a deviation from the ground truth of only 6% and structural similarity measure of 0.913 ± 0.005. In particular the high frequency weighting assists in generating projection images with sharp appearance and reduces erroneously synthesized fine details.<br

PROPHYLACTIC AND PROLONGED HYPOTHERMIA IN POOR-GRADESAH REDUCES DEGREE OF VASOSPASM AND RATE OF DELAYED CEREBRAL INFARCTIONS - Kuramatsu, J. B.; Kollmar, Rainer; Staykov, Dimitre; Kloska, Stephan; Dörfler, Arnd; Eyüpoglu, Ilker Yasin; Schwab, Stefan; Huttner, Hagen (2016)
EVALuna2:22484

Prophylactic nimodipine treatment and improvement in hearing outcome after vestibular schwannoma surgery: a combined analysis of a randomized, multicenter, Phase III trial and its pilot study - Scheller, Christian; Wienke, Andreas; Tatagiba, Marcos; Gharabaghi, Alireza; Ramina, Kristofer F.; Ganslandt, Oliver Thomas; Bischoff, Barbara; Zenk, Johannes; Engelhorn, Tobias; Matthies, Cordula; Westermaier, Thomas; Antoniadis, Gregor; et al. (Journal of Neurosurgery, 2017)
OBJECTIVE In clinical routines, neuroprotective strategies in neurosurgical interventions are still missing. A pilot study (n = 30) and an analogously performed Phase III trial (n = 112) pointed to a beneficial effect of prophylactic nimodipine and hydroxyethyl starch (HES) in vestibular schwannoma (VS) surgery. Considering the small sample size, the data from both studies were pooled. METHODS The patients in both investigator-initiated studies were assigned to 2 groups. The treatment group (n = 70) received parenteral nimodipine (1-2 mg/hour) and HES (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 72) was not treated prophylactically. Facial and cochlear nerve functions were documented preoperatively, during the inpatient care, and 1 year after surgery. RESULTS Pooled raw data were analyzed retrospectively. Intent-to-treat analysis revealed a significantly lower risk for hearing loss (Class D) 12 months after surgery in the treatment group compared with the control group (OR 0.46, 95% CI 0.22-0.97; p = 0.04). After exclusion of patients with preoperative Class D hearing, this effect was more pronounced (OR 0.38, 95% CI 0.17-0.83; p = 0.016). Logistic regression analysis adjusted for tumor size showed a 4 times lower risk for hearing loss in the treatment group compared with the control group (OR 0.25, 95% CI 0.09-0.63; p = 0.003). Facial nerve function was not significantly improved with treatment. Apart from dose-dependent hypotension (p < 0.001), the study medication was well tolerated. CONCLUSIONS Prophylactic nimodipine is safe and may be recommended in VS surgery to preserve hearing. Prophylactic neuroprotective treatment in surgeries in which nerves are at risk seems to be a novel and promising concept. Clinical trial registration no.: DRKS 00000328 ( https://drks-neu.uniklinik-freiburg.de/drks_web/ ).
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Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial - Scheller, Christian; Wienke, Andreas; Tatagiba, Marcos; Gharabaghi, Alireza; Ramina, Kristofer F.; Ganslandt, Oliver Thomas; Bischoff, Barbara; Zenk, Johannes; Engelhorn, Tobias; Matthies, Cordula; Westermaier, Thomas; Antoniadis, Gregor; et al. (Journal of Neurosurgery, 2016)
OBJECT A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. METHODS An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. RESULTS Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group]) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34-3.43], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dose-dependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. CONCLUSIONS There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.
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Propofol-related urine discoloration in a patient with fatal atypical intracerebral hemorrhage treated with hypothermia - Regensburger, Martin; Huttner, Hagen; Dörfler, Arnd; Schwab, Stefan; Staykov, Dimitre (SpringerPlus, 2014)
Introduction: Mild therapeutic hypothermia is an increasingly recognised treatment option to reduce perihemorrhagic edema in severe intracerebral hemorrhage. Case description: We report the case of a 77-year old woman with atypical intracerebral hemorrhage that was treated with mild hypothermia in addition to osmotic therapy. The patient’s urine subsequently showed a green discoloration. Urine discoloration was completely reversible upon discontinuation of propofol. Discussion and evaluation: Propofol-related urine discoloration may have been provoked by hypothermia. Due to the benign nature of this side effect, propofol should be stopped and gastrointestinal function should be supported. Conclusion: More studies are needed to show a causal role of hypothermia and related decreased enzymatic function.
CRIS-Team Scopus Importer:2021-08-17
Keywords: Enterohepatic circulation; Hypothermia; Intracerebral hemorrhage; Liver enzyme function; Urine discoloration

Pros and cons of ultra-high-field MRI/MRS for human application - Ladd, Mark E.; Bachert, Peter; Meyerspeer, Martin; Moser, Ewald; Nagel, Armin Michael; Norris, David G.; Schmitter, Sebastian; Speck, Oliver; Straub, Sina; Zaiss, Moritz (Progress in Nuclear Magnetic Resonance Spectroscopy, 2018)
Magnetic resonance imaging and spectroscopic techniques are widely used in humans both for clinical diagnostic applications and in basic research areas such as cognitive neuroimaging. In recent years, new human MR systems have become available operating at static magnetic fields of 7 T or higher (≥300 MHz proton frequency). Imaging human-sized objects at such high frequencies presents several challenges including non-uniform radiofrequency fields, enhanced susceptibility artifacts, and higher radiofrequency energy deposition in the tissue. On the other side of the scale are gains in signal-to-noise or contrast-to-noise ratio that allow finer structures to be visualized and smaller physiological effects to be detected. This review presents an overview of some of the latest methodological developments in human ultra-high field MRI/MRS as well as associated clinical and scientific applications. Emphasis is given to techniques that particularly benefit from the changing physical characteristics at high magnetic fields, including susceptibility-weighted imaging and phase-contrast techniques, imaging with X-nuclei, MR spectroscopy, CEST imaging, as well as functional MRI. In addition, more general methodological developments such as parallel transmission and motion correction will be discussed that are required to leverage the full potential of higher magnetic fields, and an overview of relevant physiological considerations of human high magnetic field exposure is provided.
EVALuna2:36229

Prospective intraindividual comparison of gadoterate and gadobutrol for cervical and intracranial contrast-enhanced magnetic resonance angiography - Lang, Stefan; Weibart, Marina; Schmidt, Manuel; Knott, Michael; Engelhorn, Tobias; Essig, Marco; Kloska, Stephan; Dörfler, Arnd; Hölter, Philip (Neuroradiology, 2017)
PURPOSE: Gadobutrol (GB) is reported to provide improved relaxivity and concentration compared to gadoterate (GT). This study was designed to intraindividually compare quantitative and qualitative enhancement characteristics of GB to GT in cervicocranial magnetic resonance angiography (MRA) of patients with cerebrovascular disease (CVD). METHODS: Patients (n = 54) with CVD underwent two identical contrast-enhanced magnetic resonance angiography (CE-MRA) examinations of the cervical and intracranial vasculature in randomized order, using GB and GT in equimolar dose. Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were obtained by two independent neuroradiologists, blinded to the applied contrast agents. Qualitative assessment was performed using a three-point scale with a focus on M1/M2 segments. RESULTS: One thousand and twenty-six vessel segments were analyzed. GB revealed a significantly higher SNR (p = 0.032) and CNR (p = 0.031) in all vessel segments. GB featured a significantly higher SNR and CNR in thoracic (p = 0.022; p = 0.016) and cervical vessels (p = 0.03; p = 0.038), as well as in the posterior circulation (p = 0.012; p = 0.005). In blinded qualitative assessment, overall preference was given to GB (p = 0.02), showing a significant better delineation of the M1/M2 segments (p = 0.041). CONCLUSION: Compared to GT, the use of GB results in a significantly higher SNR and CNR in cervical and cerebral CE-MRA, leading to a better delineation of the intracranial vasculature. Present results underline the potential of GB for improved CE-MRA assessment of vasculature in CVD patients.
EVALuna2:33134

Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: Feasibility, image quality, radiation dose, and effect of iterative reconstruction - Hell, Michaela M.; Bittner, Daniel; Schuhbaeck, Annika; Muschiol, Gerd; Brand, Michael; Lell, Michael; Uder, Michael; Achenbach, Stephan; Marwan, Mohamed (Journal of Cardiovascular Computed Tomography, 2014)
Low tube voltage reduces radiation exposure in coronary CT angiography (CTA). Using 70 kVp tube potential has so far not been possible because CT systems were unable to provide sufficiently high tube current with low voltage.We evaluated feasibility, image quality (IQ), and radiation dose of coronary CTA using a third-generation dual-source CT system capable of producing 450 mAs tube current at 70 kVp tube voltage.Coronary CTA was performed in 26 consecutive patients with suspected coronary artery disease, selected for body weight <100 kg and heart rate <60 beats/min. High-pitch spiral acquisition was used. Filtered back projection (FBP) and iterative reconstruction (IR) algorithms were applied. IQ was assessed using a 4-point rating scale (1 = excellent, 4 = nondiagnostic) and objective parameters.Mean age was 62 ± 9 years (46% males; mean body mass index, 27.7 ± 3.8 kg/m(2); mean heart rate, 54 ± 5 beats/min). Mean dose-length product was 20.6 ± 1.9 mGy × cm; mean estimated effective radiation dose was 0.3 ± 0.03 mSv. Diagnostic IQ was found in 365 of 367 (FBP) and 366 of 367 (IR) segments (P nonsignificant). IQ was rated "excellent" in 53% (FBP) and 86% (IR) segments (P = .001) and "nondiagnostic" in 2 (FBP) and 1 segment (IR) (P nonsignificant). Mean IQ score was lesser in FBP vs IR (1.5 ± 0.4 vs 1.1 ± 0.2; P < .001). Image noise was lower in IR vs FBP (60 ± 10 HU vs 74 ± 8 HU; P < .001).In patients <100 kg and with a regular heart rate <60 beats/min, third-generation dual-source CT using high-pitch spiral acquisition and 70 kVp tube voltage is feasible and provides both robust IQ and very low radiation exposure.
EVALuna2:11954

Protocol Recommendations of the AG Imaging Procedures of the Musculoskeletal System (AG BVB) to Measurement Sequences for Finger, Foot and Temporomandibular Joint - Rehnitz, Christoph; Janka, Rolf Matthias (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2019)
CRIS-Team WoS Importer:2019-04-12

Protokollempfehlungen der AG Bildgebende Verfahren des Bewegungsapparats (AG BVB) zu Mess-Sequenzen für Finger, Fuß und Kiefergelenk - Rehnitz, Christoph; Janka, Rolf Matthias (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2019)
CRIS-Team Scopus Importer:2019-06-04

PSMA SPECT/CT with 99mTc-MIP-1404 in biochemical recurrence of prostate cancer: predictive factors and efficacy for the detection of PSMA-positive lesions at low and very-low PSA levels - Schmidkonz, Christian; Götz, Theresa; Kuwert, Torsten; Ritt, Philipp; Prante, Olaf; Bäuerle, Tobias; Goebell, Peter; Cordes, Michael (Annals of Nuclear Medicine, 2019)
Background: The in vivo expression of the prostate-specific membrane antigen (PSMA) can be investigated using the SPECT-suitable tracer 99mTc-MIP-1404. We investigated the performance of 99mTc-MIP-1404 PSMA SPECT/CT in the detection of PSMA-positive tumor lesions in patients suffering from biochemical recurrence of prostate cancer presenting with serum levels of the prostate-specific antigen (PSA) below 1 ng/mL. Methods: We retrospectively analyzed 99mTc-MIP-1404-SPECT/CT scans of 50 patients (25 with low PSA levels between > 0.5 and 1 ng/mL and 25 with very low PSA levels between 0.2 and 0.5 ng/mL) that had undergone whole-body planar scintigraphy and SPECT/CT of the thorax, abdomen and pelvis 3–4 h p.i. of 691 ± 72 MBq 99mTc-MIP-1404. All datasets were evaluated for the presence and location of PSMA-positive tumor lesions, in which maximal standardized uptake values (SUVmax) were also measured. Based on the results of the quantitative evaluation as well as on biochemical and histological parameters, predictive factors for a positive 99mTc-MIP-1404 scan result were determined. The influence of 99mTc-MIP-1404 PSMA SPECT/CT on further therapy planning was assessed, based on the decision-making of the interdisciplinary tumor board. Results: Pathological 99mTc-MIP-1404 uptake was detected in a total of 25 patients (50%). In the very low PSA subgroup, detection rates of PSMA-positive lesions suggestive of tumor recurrence were 44%, in the low-PSA subgroup 56%. Gleason scores ≥ 8 and the presence of antiandrogen deprivation therapy were further significant predictors of pathological 99mTc-MIP-1404 uptake. This was paralleled by significantly higher lesional SUVmax patients with PSA levels > 0.5 ng/mL and Gleason scores ≥ 8 compared to those without these two features. Changes in therapeutic strategy following MIP-1404 imaging were recommended by the interdisciplinary tumor board in 25/50 of patients. Conclusion: 99mTc-MIP-1404 PSMA-SPECT/CT demonstrated a high performance in detecting PSMA-positive lesions suggestive of tumor recurrence in patients with biochemical recurrence of prostate cancer and low and very low serum PSA levels. Results from MIP-1404 PSMA SPECT/CT have therapeutic impact in one-half of the patients examined by this technology.
CRIS-Team Scopus Importer:2019-10-29
Keywords: Low PSA levels; MIP-1404; Prostate cancer; PSMA; Quantitative SPECT/CT; SPECT/CT

Psychological and Pain Sensitization Characteristics Are Associated With Patellofemoral Osteoarthritis Symptoms: The Multicenter Osteoarthritis Study - Collins, Natalie J.; Neogi, Tuhina; Vicenzino, Bill; Guermazi, Ali; Roemer, Frank; Lewis, Cora E.; Torner, James C.; Nevitt, Michael C.; Stefanik, Joshua J. (Journal of Rheumatology, 2020)
OBJECTIVE: Determine the relation of symptomatic and structural features of patellofemoral osteoarthritis (PFOA) to psychological characteristics and measures of pain sensitization, in older adults with or at risk of knee osteoarthritis (OA). METHODS: This study included 1112 participants from the Multicenter Osteoarthritis Study (713 females, mean age 66.8 ± SD 7.6 yrs, body mass index 29.5 ± 4.8 kg/m2). Participants were grouped based on the presence of PFOA symptoms (anterior knee pain and pain on stairs) and magnetic resonance imaging (MRI) PFOA (full-thickness cartilage lesion with bone marrow lesion): (1) patellofemoral (PF) symptoms with MRI PFOA; (2) PF symptoms without MRI PFOA; (3) MRI PFOA without PF symptoms; and (4) no PF symptoms or MRI PFOA (no PFOA). Relation of PFOA classification to depressive symptoms, catastrophizing, temporal summation (TS) and pressure pain thresholds (PPT) was evaluated using logistic (categorical variables) and linear regression (continuous variables). RESULTS: Compared with no PFOA, those with PF symptoms with or without MRI PFOA had significantly greater odds of depressive symptoms, catastrophizing, and patellar TS (OR range 1.5-2.01), and those with PF symptoms without MRI PFOA had significantly greater odds of wrist TS (OR 1.66). Males with PF symptoms without MRI PFOA had significantly lower pressure PPT at the patella compared with no PFOA and those with MRI PFOA only (no symptoms). There were no significant differences at the wrist for males, or the patella or wrist for females. CONCLUSION: Persons with PFOA symptoms, regardless of MRI PFOA status, are more likely to demonstrate depressive symptoms, catastrophizing, and TS. Males with PFOA symptoms without MRI PFOA demonstrate local hyperalgesia.
CRIS-Team Scopus Importer:2020-11-13
Keywords: knee; magnetic resonance imaging; osteoarthritis; pain

PU.1-driven Th9 Cells Promote Colorectal Cancer in Experimental Colitis Models Through Il-6 Effects in Intestinal Epithelial Cells - Gerlach, Katharina; Popp, Vanessa; Wirtz, Stefan; Al-Saifi, Ragheed; Gonzalez Acera, Miguel; Atreya, Raja; Dregelis, Theresa; Vieth, Michael; Fichtner-Feigl, Stefan; Mckenzie, Andrew N. J.; Rosenbauer, Frank; Weigmann, Benno; et al. (Journal of Crohns & Colitis, 2022)
Background and Aims Colorectal cancer [CRC] is one of the most frequent malignancies, but the molecular mechanisms driving cancer growth are incompletely understood. We characterised the roles of the cytokine IL-9 and Th9 cells in regulating CRC development. Methods CRC patient samples and samples from AOM/DSS treated mice were analysed for expression of IL-9, CD3, and PU.1 by FACS analysis and immunohistochemistry. IL-9 citrine reporter mice, IL-9 knockout mice, and PU.1 and GATA3 CD4-Cre conditional knockout mice were studied in the AOM/DSS model. DNA minicircles or hyper-IL-6 were used for overexpression of cytokines in vivo. Effects of IL-6 and IL-9 were determined in organoid and T cell cultures. Claudin2/3 expression was studied by western blotting and bacterial translocation by FISH. Results We uncovered a significant expansion of IL-9- and PU.1-expressing mucosal Th9 cells in CRC patients, with particularly high levels in patients with colitis-associated neoplasias. PU.1(+) Th9 cells accumulated in experimental colorectal neoplasias. Deficiency of IL-9 or inactivation of PU.1 in T cells led to impaired tumour growth in vivo, suggesting a protumoral role of Th9 cells. In contrast, GATA3 inactivation did not affect Th9-mediated tumour growth. Mechanistically, IL-9 controls claudin2/3 expression and T cell-derived IL-6 production in colorectal tumours. IL-6 abrogated the anti-proliferative effects of IL-9 in epithelial organoids in vivo. IL-9-producing Th9 cells expand in CRC and control IL-6 production by T cells. Conclusions IL-9 is a crucial regulator of tumour growth in colitis-associated neoplasias and emerges as potential target for therapy.
CRIS-Team WoS Importer:2022-09-16

Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering - Lutter, Christoph; Schweizer, Andreas; Hochholzer, Thomas; Bayer, Thomas; Schöffl, Volker (Wilderness & Environmental Medicine, 2016)
Hamate hook fractures are rare injuries, comprising 2% to 4% of all carpal fractures. Climbing athletes seem to be affected more frequently than others, as they strain the passive and active anatomical structures of their hands and fingers to maximum capacity during training or competing. This stress is transmitted to the hook of the hamate by tightened flexor tendons, which creates high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by contact pressure of the anatomical structures, are rare and occur nearly exclusively during climbing.We diagnosed 12 athletes with hamate hook fractures who presented with diffuse pain in the wrist joint, which occurred either during or after climbing. Radiographs or computed tomography revealed fractures in the hamate bones in most of the patients; therapy consisted of consequent stress reduction.Follow-up investigations found that all athletes were free of symptoms after 10.7 ± 5.1 (6-24) (mean ± standard deviation with range) weeks. Resection of the hamate hook was necessary in 3 patients. All patients regained their preinjury climbing level.Climbers with an unspecific, diffuse pain in the wrist need to be examined by radiograph and, if radiograph is unclear, computed tomography or magnetic resonance imaging to detect or exclude the diagnosis of hamate fracture in order to avoid severe complications.
EVALuna2:14717

Pulmonary Dysfunction after Pediatric COVID-19 - Heiß, Rafael; Tan, Lina; Schmidt, Sandy; Regensburger, Adrian; Ewert, Franziska; Mammadova, Dilbar; Bühler, Adrian; Vogel-Claussen, Jens; Voskrebenzev, Andreas; Rauh, Manfred; Rompel, Oliver; Nagel, Armin Michael; et al. (Radiology, 2022)
Background Long COVID occurs in lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field MRI may identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma on low-field MRI in children and adolescents with post COVID-19 compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional, prospective clinical trial using low-field MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes on MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive RT-PCR test and serological parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants and with long COVID. Results A total of 54 participants post COVID-19 infection (mean age, 11 years ±3 [SD], 56 males) and 9 healthy controls (mean age, 10 years ±3 [SD], 70 males) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (V/Q match) was reduced from 81±6.1% in healthy controls to 62±19% (P =.006) in the recovered group and 60±20% (P=.003) in the long COVID group. V/Q match was lower in post COVID patients with infection less than 180 days (63±20%, P=.03), 180 to 360 days (63±18%, P=0.03) and 360 days ago (41±12%, P<.001) as compared with the never-infected healthy controls (81±6.1%). Conclusion Low-field MRI showed persistent pulmonary dysfunction in both children and adolescents recovered from COVID-19 and with long COVI

Pulsed Arterial Spin Labeling and Segmented Brain Volumetry in the Diagnostic Evaluation of Frontotemporal Dementia, Alzheimer’s Disease and Mild Cognitive Impairment - Marterstock, Dominique; Knott, Michael; Lang, Stefan; Oberstein, Timo; Kornhuber, Johannes; Dörfler, Arnd; Schmidt, Manuel; Hölter, Philip (Tomography, 2022)
Background: Previous studies suggest that brain atrophy can not only be defined by its morphological extent, but also by the cerebral blood flow (CBF) within a certain area of the brain, including white and gray matter. The aim of this study is to investigate known atrophy patterns in different forms of dementia and to compare segmented brain volumetrics and pulsed arterial spin labeling (pASL) data to explore the correlation between brain maps with atrophy and this non-contrast-enhanced brain-perfusion method. Methods: Our study comprised 17 patients with diagnosed cognitive impairment (five Alzheimer’s disease = AD, five frontotemporal dementia = FTD, seven mild cognitive impairment = MCI) and 19 healthy control subjects (CO). All patients and controls underwent 4D-pASL brain-perfusion MR imaging and T1w MPRAGE. The data were assessed regarding relative brain volume on the basis of 286 brain regions, and absolute and relative cerebral blood flow (CBF/rCBF) were derived from pASL data in the corresponding brain regions. Mini-Mental State Examination (MMSE) was performed to assess cognitive functions. Results: FTD patients demonstrated significant brain atrophy in 43 brain regions compared to CO. Patients with MCI showed significant brain atrophy in 18 brain regions compared to CO, whereas AD patients only showed six brain regions with significant brain atrophy compared to CO. There was good correlation of brain atrophy and pASL perfusion data in five brain regions of patients with diagnosed FTD, especially in the superior temporal gyrus (r = 0.900, p = 0.037), the inferior frontal white matter (pars orbitalis; r = 0.968, p = 0.007) and the thalami (r = 0.810, p = 0.015). Patients with MCI demonstrated a correlation in one brain region (left inferior fronto-occipital fasciculus; r = 0.786, p = 0.036), whereas patients with diagnosed AD revealed no correlation. Conclusions: pASL can detect affected brain regions in cognitive impairment and corresponds with brain atrophy, especially for patients suffering from FTD and MCI. However, there was no correlation of perfusion alterations and brain atrophy in AD. pASL perfusion might thus represent a promising tool for noninvasive brain-perfusion evaluation in specific dementia subtypes as a complimentary imaging-based bio marker in addition to brain volumetry.
CRIS-Team Scopus Importer:2022-02-11
Keywords: Alzheimer’s disease; Brain volumetry; Dementia; Frontotemporal dementia; Mild cognitive impairment; Pulsed arterial spin labeling

Pulseq-CEST: Towards multi-site multi-vendor compatibility and reproducibility of CEST experiments using an open-source sequence standard - Herz, Kai; Mueller, Sebastian; Perlman, Or; Zaitsev, Maxim; Knutsson, Linda; Sun, Phillip Zhe; Zhou, Jinyuan; Van Zijl, Peter; Heinecke, Kerstin; Schuenke, Patrick; Farrar, Christian T.; Schmidt, Manuel; et al. (Magnetic Resonance in Medicine, 2021)
Purpose As the field of CEST grows, various novel preparation periods using different parameters are being introduced. At the same time, large, multisite clinical studies require clearly defined protocols, especially across different vendors. Here, we propose a CEST definition standard using the open Pulseq format for a shareable, simple, and exact definition of CEST protocols.
CRIS-Team WoS Importer:2021-05-28

Pupillometry in the follow-up of patients undergoing EVT - prediction of space-occupying hemispheric infarction - Kossel, Clara-Sophie; Kobus, Franca; Borutta, Matthias; Kärtner, Maximilian; Kuramatsu, Joji; Engelhorn, Tobias; Schwab, Stefan; Köhn, Julia (Journal of Neurology, 2023)
Background: Despite benefits of endovascular treatment (EVT) for large vessel occlusion (LVO) ischemic stroke, space-occupying brain edema (BE) represents a detrimental complication. In critical-care settings, CT-imaging is needed for monitoring these patients. Yet, bed-side techniques with the potential to predict whether patients develop BE or not would facilitate a time- and cost-efficient patient care. We assessed clinical significance of automated pupillometry in the follow-up of patients undergoing EVT. Methods: From 10/2018 to 10/2021, neurocritical-care-unit patients were retrospectively enrolled after EVT of anterior circulation LVO. We monitored parameters of pupillary reactivity [light-reflex-latency (Lat), constriction- and redilation-velocities (CV, DV), percentage-change-of-apertures (per-change); NeurOptics-pupilometer®] up to every hour on day 1–3 of ICU stay. BE was defined as midline shift ≥ 5 mm on follow-up imaging 3–5 days after EVT. We calculated mean values of intra-individual differences between successive pairs of parameters (mean-deltas), determined best discriminative cut-off values for BE development (ROC-analyses), and evaluated prognostic performance of pupillometry for BE development (sensitivity/specificity/positive-/negative-predictive-values). Results: 3241 pupillary assessments of 122 patients [67 women, 73 years (61.0–85.0)] were included. 13/122 patients developed BE. Patients with BE had significantly lower CVs, DVs, and smaller per-changes than patients without BE. On day 1 after EVT mean-deltas of CV, DV, and per-changes were significantly lower in patients with than without BE. Positive-predictive-values of calculated thresholds to discriminate both groups were considerably low, yet, we found high negative-predictive-values for CV, DV, per-changes, and mean-deltas (max.: 98.4%). Conclusion: Our data suggest associations between noninvasively detected changes in pupillary reactivity and BE early after LVO-EVT. Pupillometry may identify patients who are unlikely to develop BE and may not need repetitive follow-up-imaging or rescue-therapy.
CRIS-Team Scopus Importer:2023-06-30
Keywords: Automated pupillometry; Endovascular treatment; Ischemic stroke; Large vessel occlusion; Pupillary reactivity

Quality assurance guidelines for interstitial hyperthermia - Trefna, H. Dobsicek; Schmidt, Manuel; Van Rhoon, G. C.; Kok, H. P.; Gordeyev, S. S.; Lamprecht, U.; Marder, D.; Nadobny, J.; Ghadjar, P.; Abdel-Rahman, S.; Kukielka, A. M.; Strnad, Vratislav; et al. (International Journal of Hyperthermia, 2019)
Quality assurance (QA) guidelines are essential to provide uniform execution of clinical hyperthermia treatments and trials. This document outlines the clinical and technical consequences of the specific properties of interstitial heat delivery and specifies recommendations for hyperthermia administration with interstitial techniques. Interstitial hyperthermia aims at tumor temperatures in the 40-44 degrees C range as an adjunct to radiation or chemotherapy. The clinical part of this document imparts specific clinical experience of interstitial heat delivery to various tumor sites as well as recommended interstitial hyperthermia workflow and procedures. The second part describes technical requirements for quality assurance of current interstitial heating equipment including electromagnetic (radiative and capacitive) and ultrasound heating techniques. Detailed instructions are provided on characterization and documentation of the performance of interstitial hyperthermia applicators to achieve reproducible hyperthermia treatments of uniform high quality. Output power and consequent temperature rise are the key parameters for characterization of applicator performance in these QA guidelines. These characteristics determine the specific maximum tumor size and depth that can be heated adequately. The guidelines were developed by the ESHO Technical Committee with participation of senior STM members and members of the Atzelsberg Circle.
CRIS-Team WoS Importer:2019-04-09

Quality requirements for MRI simulation in cranial stereotactic radiotherapy: a guideline from the German Taskforce “Imaging in Stereotactic Radiotherapy” - Putz, Florian; Bock, Michael; Schmitt, Daniela; Bert, Christoph; Blanck, Oliver; Ruge, Maximilian I.; Hattingen, Elke; Karger, Christian P.; Fietkau, Rainer; Grigo, Johanna; Schmidt, Manuel; Bäuerle, Tobias; et al. (Strahlentherapie und Onkologie, 2024)
Accurate Magnetic Resonance Imaging (MRI) simulation is fundamental for high-precision stereotactic radiosurgery and fractionated stereotactic radiotherapy, collectively referred to as stereotactic radiotherapy (SRT), to deliver doses of high biological effectiveness to well-defined cranial targets. Multiple MRI hardware related factors as well as scanner configuration and sequence protocol parameters can affect the imaging accuracy and need to be optimized for the special purpose of radiotherapy treatment planning. MRI simulation for SRT is possible for different organizational environments including patient referral for imaging as well as dedicated MRI simulation in the radiotherapy department but require radiotherapy-optimized MRI protocols and defined quality standards to ensure geometrically accurate images that form an impeccable foundation for treatment planning. For this guideline, an interdisciplinary panel including experts from the working group for radiosurgery and stereotactic radiotherapy of the German Society for Radiation Oncology (DEGRO), the working group for physics and technology in stereotactic radiotherapy of the German Society for Medical Physics (DGMP), the German Society of Neurosurgery (DGNC), the German Society of Neuroradiology (DGNR) and the German Chapter of the International Society for Magnetic Resonance in Medicine (DS-ISMRM) have defined minimum MRI quality requirements as well as advanced MRI simulation options for cranial SRT.
CRIS-Team Scopus Importer:2024-01-12
Keywords: Brain metastases; DEGRO; DGMP; DGNC; DGNR; DS-ISMRM; Guideline; Meningioma; MRI simulation; Pituitary adenoma; Stereotactic radiosurgery; Stereotactic radiotherapy; Trigeminal neuralgia; Vestibular schwannoma

Quantifiable Contrast-Enhanced Ultrasound Explores the Role of Protection, Rest, Ice (Cryotherapy), Compression and Elevation (PRICE) Therapy on Microvascular Blood Flow - Hotfiel, Thilo; Hoppe, Matthias Wilhelm; Heiß, Rafael; Lutter, Christoph; Tischer, Thomas; Forst, Raimund; Hammer, Christian; Freiwald, Jürgen; Engelhardt, Martin; Grim, Casper (Ultrasound in Medicine and Biology, 2021)
The aim of this randomized controlled laboratory study was to evaluate the role of standardized protection, rest, ice (cryotherapy), compression and elevation (PRICE) therapy on microvascular blood flow in human skeletal muscle. Quantifiable contrast-enhanced ultrasound was used to analyze intramuscular tissue perfusion (ITP) of the rectus femoris (RF) and vastus intermedius (VI) muscles in 20 healthy athletes who were randomly assigned to PRICE or control groups. Baseline perfusion measurements (resting conditions, T0) were compared with cycling exercise (T1), intervention (PRICE or control, T2) and follow-up at 60 min post-intervention (T3). The 20 min PRICE intervention included rest, cryotherapy (3°C), compression (35 mm Hg) and elevation. After intervention, PRICE demonstrated a decrease of ITP in VI (–47%, p = 0.01) and RF (–50%, p = 0.037) muscles. At T3, an ongoing decreased ITP for the RF (p = 0.003) and no significant changes for the VI were observed. In contrast, the control group showed an increased ITP at T2 and no significant differences at T3. PRICE applied after exercise led to a down-regulation of ITP, and the termination of PRICE does not appear to be associated with a reactive hyperemia for at least 60 min after treatment.
CRIS-Team Scopus Importer:2021-02-12
Keywords: CEUS; Compression; Cryotherapy; ICE; Muscle injuries; Muscle metabolism; RICE; Sports injuries; Ultrasound

Quantification of change in vocal fold tissue stiffness relative to depth of artificial damage - Rohlfs, Anna-Katharina; Schmolke, Sebastian; Clauditz, Till; Hess, Markus; Mueller, Frank; Pueschel, Klaus; Roemer, Frank; Schumacher, Udo; Goodyer, Eric (Logopedics Phoniatrics Vocology, 2017)
To quantify changes in the biomechanical properties of human excised vocal folds with defined artificial damage.The linear skin rheometer (LSR) was used to obtain a series of rheological measurements of shear modulus from the surface of 30 human cadaver vocal folds. The tissue samples were initially measured in a native condition and then following varying intensities of thermal damage. Histological examination of each vocal fold was used to determine the depth of artificial alteration. The measured changes in stiffness were correlated with the depth of cell damage.For vocal folds in a pre-damage state the shear modulus values ranged from 537 Pa to 1,651 Pa (female) and from 583 Pa to 1,193 Pa (male). With increasing depth of damage from the intermediate layer of the lamina propria (LP), tissue stiffness increased consistently (compared with native values) following application of thermal damage to the vocal folds. The measurement showed an increase of tissue stiffness when the depth of tissue damage was extending from the intermediate LP layer downwards.Changes in the elastic characteristics of human vocal fold tissue following damage at defined depths were demonstrated in an in vitro experiment. In future, reproducible in vivo measurements of elastic vocal fold tissue alterations may enable phonosurgeons to infer the extent of subepithelial damage from changes in surface elasticity.
EVALuna2:14647

Quantification of hand muscle volume and composition in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis - Friedberger, Andreas; Figueiredo, Camille; Grimm, Alexandra; Oliveira, Isabelle; Bäuerle, Tobias; Rech, Jürgen; Kleyer, Arnd; Simon, David; Uder, Michael; Schett, Georg; Engelke, Klaus (BMC Musculoskeletal Disorders, 2020)
Background Psoriasis (Pso), psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are inflammatory diseases. PsA and RA are characterized by bone and muscle loss. In RA, bone loss has been extensively characterized, but muscle loss has, to the best of our knowledge, not been quantified to date. Methods A random forest based segmentation method was used to analyze hand muscle volume in T1 weighted MRI images of 330 patients suffering from Pso, PsA or RA. In addition, fat volume was quantified using MRI Dixon sequences in a small subset (n = 32). Results Males had a higher relative muscle volume than females (14% for Pso, 11% for PsA, n.s. for RA). Between 40 and 80 years male Pso patients lost 13%, male PsA patients 16%, male RA patients 23% and female PsA patients 30% of their relative muscle volume. After adjustment for age, relative muscle volume in males RA patients was 16% and in female RA patients 9% lower than in Pso patients. In male RA patients relative muscle volume was 13% lower in than in male PsA patients. There was no difference in females. A significant negative correlation (R-2 = 0.18) between relative intramuscular fat content relative hand muscle volume was observed. Conclusion These preliminary data showed that relative hand muscle volume significantly decreased with age in male and female patients with Pso, PsA and RA patients. Independent of age, relative hand muscle volume was significantly smaller in patients with RA compared to the patients with Pso and the difference was twice as large in males compared to females. Also in male but not in female RA patients relative hand muscle volume was significantly smaller than in PsA patients.
CRIS-Team WoS Importer:2020-04-14

Quantification of plaque lipids in the aortic root of ApoE-deficient mice by 3D DIXON magnetic resonance imaging in an ex vivo model - Dietel, Barbara; Budinsky, Lubos; Kühn, Constanze; Uder, Michael; Achenbach, Stephan; Heß, Andreas (European Radiology, 2015)
To establish a dedicated protocol for the three-dimensional (3D) quantification of plaque lipids in apolipoprotein E-deficient (apoE(-/-)) mice using ex vivo MRI.ApoE(-/-) mice were fed a high-fat diet (n = 10) or normal food (n = 10) for 3 months. Subsequently, a 3D FLASH MRI sequence was used to view the anatomy of the aortic root in the isolated hearts, where a 3D double-echo two-excitation pulse sequence (DIXON sequence) was used to selectively image plaque lipids. The vessel wall, lumen and plaque lipid volumes were quantified by MRI and histology for correlation analysis.DIXON MRI allowed visualisation and accurate quantification of plaque lipids. When comparing the vessel wall, lumen and plaque lipid sizes in the aortic root, Bland-Altman and linear regression analysis revealed a close correlation between MRI results and the histological data both on a slice-by-slice basis and of the volumetric measurements (vessel wall: r (2) = 0.775, p < 0.001; vessel lumen: r (2) = 0.875; p = 0.002; plaque lipid: r (2) = 0.819, p = 0.003).The combination of 3D FLASH and DIXON-sequence MRI permits an accurate ex vivo assessment of the investigated plaque parameters in the aortic root of mice, particularly the lipid content.o Ex vivo MRI allows high resolution quantification of plaque parameters in mice o DIXON MRI enables visualisation of plaque lipids in the aortic root of mice o A close correlation between histology and MRI quantifies plaque parameters o Preservation of tissue integrity allows additional analysis to be performed o Short measurement time may permit the translation into in vivo measurements.
EVALuna2:11953

Quantification of Sodium Relaxation Times and Concentrations as Surrogates of Proteoglycan Content of Patellar CARTILAGE at 3T MRI - Kamp, Benedikt; Frenken, Miriam; Henke, Jan M.; Abrar, Daniel B.; Nagel, Armin Michael; Gast, Lena; Oeltzschner, Georg; Wilms, Lena M.; Nebelung, Sven; Antoch, Gerald; Wittsack, Hans-Joerg; Mueller-Lutz, Anja (Diagnostics, 2021)
Sodium MRI has the potential to depict cartilage health accurately, but synovial fluid can influence the estimation of sodium parameters of cartilage. Therefore, this study aimed to reduce the impact of synovial fluid to render the quantitative compositional analyses of cartilage tissue technically more robust. Two dedicated protocols were applied for determining sodium T-1 and T-2* relaxation times. For each protocol, data were acquired from 10 healthy volunteers and one patient with patellar cartilage damage. Data recorded with multiple repetition times for T-1 measurement and multi-echo data acquired with an additional inversion recovery pulse for T-2* measurement were analysed using biexponential models to differentiate longitudinal relaxation components of cartilage (T-1,T-car) and synovial fluid (T-1,T-syn), and short (T-2s*) from long (T-2l*) transversal relaxation components. Sodium relaxation times and concentration estimates in patellar cartilage were successfully determined: T-1,T-car = 14.5 & PLUSMN; 0.7 ms; T-1,T-syn = 37.9 & PLUSMN; 2.9 ms; c(T-1-protocol) = 200 & PLUSMN; 48 mmol/L; T-2s* = 0.4 & PLUSMN; 0.1 ms; T-2l* = 12.6 & PLUSMN; 0.7 ms; c(T-2*-protocol) = 215 & PLUSMN; 44 mmol/L for healthy volunteers. In conclusion, a robust determination of sodium relaxation times is possible at a clinical field strength of 3T to quantify sodium concentrations, which might be a valuable tool to determine cartilage health.
CRIS-Team WoS Importer:2022-01-14

Quantification of translocation-specific ctDNA provides an integrating parameter for early assessment of treatment response and risk stratification in ewing sarcoma - Krumbholz, Manuela; Eiblwieser, Johanna; Ranft, Andreas; Zierk, Jakob; Schmidkonz, Christian; Stuetz, Adrian M.; Peneder, Peter; Tomazou, Eleni M.; Agaimy, Abbas; Bäuerle, Tobias; Hartmann, Wolfgang; Dirksen, Uta; et al. (Clinical Cancer Research, 2021)
Purpose: We evaluated the predictive and prognostic value of circulating tumor DNA (ctDNA) in patients with Ewing sarcoma (EWS) treated in the EWING2008 trial. Experimental Design: Plasma samples from 102 patients with EWS enrolled in the EWING2008 trial were obtained before and during induction chemotherapy. Genomic EWSR1 fusion sequence spanning primers and probes were used for highly specific and sensitive quantification of the levels of ctDNA by digital droplet PCR. ctDNA levels were correlated to established clinical risk factors and outcome parameters. Results: Pretreatment ctDNA copy numbers were correlated with event-free and overall survival. The reduction in ctDNA levels below the detection limit was observed in most cases after only two blocks of vincristine, ifosfamide, doxorubicin, and etoposide (VIDE) induction chemotherapy. The persistence of ctDNA after two VIDE blocks was a strong predictor of poor outcomes. ctDNA levels correlated well with most established clinical risk factors; an inverse correlation was found only for the histologic response to induction therapy. ctDNA levels did not provide simple representations of tumor volume, but integrated information from various tumor characteristics represented an independent EWS tumor marker with predictive and prognostic value. Conclusions: ctDNA copy number in the plasma of patients with EWS is a quantifiable parameter for early risk stratification and can be used as a dynamic noninvasive biomarker for early prediction of treatment response and outcome of patients.
CRIS-Team Scopus Importer:2021-11-26

Quantitative 1H and 23Na muscle MRI in Facioscapulohumeral muscular dystrophy patients - Gerhalter, Teresa; Marty, Benjamin; Gast, Lena; Porzelt, Katharina; Heiß, Rafael; Uder, Michael; Schwab, Stefan; Carlier, Pierre G.; Nagel, Armin Michael; Türk, Matthias (Journal of Neurology, 2020)
Objective: Our aim was to assess the role of quantitative 1H and 23Na MRI methods in providing imaging biomarkers of disease activity and severity in patients with Facioscapulohumeral muscular dystrophy (FSHD). Methods: We imaged the lower leg muscles of 19 FSHD patients and 12 controls with a multimodal MRI protocol to obtain STIR-T2w images, fat fraction (FF), water T2 (wT2), water T1 (wT1), tissue sodium concentration (TSC), and intracellular-weighted sodium signal (inversion recovery (IR) and triple quantum filter (TQF) sequence). In addition, the FSHD patients underwent muscle strength testing. Results: Imaging biomarkers related with water mobility (wT1 and wT2) and ion homeostasis (TSC, IR, TQF) were increased in muscles of FSHD patients. Muscle groups with FF > 10% had higher wT2, wT1, TSC, IR, and TQF values than muscles with FF < 10%. Muscles with FF < 10% resembled muscles of healthy controls for these MRI disease activity measures. However, wT1 was increased in few muscles without fat replacement. Furthermore, few STIR-negative muscles (n = 11/76) exhibited increased wT1, TSC, IR or TQF. Increased wT1 as well as 23Na signals were also present in muscles with normal wT2. Muscle strength was related to the mean FF and all imaging biomarkers of tibialis anterior except wT2 were correlated with dorsal flexion. Conclusion: The newly evaluated imaging biomarkers related with water mobility (wT1) and ion homeostasis (TSC, IR, TQF) showed different patterns compared to the established markers like FF in muscles of FSHD patients. These quantitative biomarkers could thus contain valuable complementary information for the early characterization of disease progression.
CRIS-Team Scopus Importer:2020-10-23
Keywords: Facioscapulohumeral muscular dystrophy; Quantitative MRI; Sodium MRI; Triple quantum filter; Water T

Quantitative 7T sodium magnetic resonance imaging of the human brain using a 32-channel phased-array head coil: Application to patients with secondary progressive multiple sclerosis - Wilferth, Tobias; Mennecke, Angelika; Gast, Lena; Lachner, Sebastian; Müller, Max; Rothhammer, Veit; Huhn, Konstantin; Uder, Michael; Dörfler, Arnd; Nagel, Armin Michael; Schmidt, Manuel (NMR in Biomedicine, 2022)
Apparent tissue sodium concentrations (aTSCs) determined by 23Na brain magnetic resonance imaging (MRI) have the potential to serve as a biomarker in pathologies such as multiple sclerosis (MS). However, the quantification is hindered by the intrinsically low signal-to-noise ratio of 23Na MRI. The purpose of this study was to improve the accuracy and reliability of quantitative 23Na brain MRI by implementing a dedicated postprocessing pipeline and to evaluate the applicability of the developed approach for the examination of MS patients. 23Na brain MRI measurements of 13 healthy volunteers and 17 patients with secondary progressive multiple sclerosis (SPMS) were performed at 7 T using a dual-tuned 23Na/1H birdcage coil with a receive-only 32-channel phased array. The aTSC values were determined for normal appearing white matter (NAWM) and normal appearing gray matter (NAGM) in healthy subjects and SPMS patients. Signal intensities were normalized using the mean cerebrospinal fluid (CSF) sodium concentration determined in 37 separate patients receiving a spinal tap for routine diagnostic purposes. Five volunteers underwent MRI examinations three times in a row to assess repeatability. Coefficients of variation (CoVs) were used to quantify the repeatability of the proposed method. aTSC values were compared regarding brain regions and subject cohort using the paired-samples Wilcoxon rank-sum test. Laboratory CSF sodium concentration did not differ significantly between patients without and with MS (p = 0.42). The proposed quantification workflow for 23Na MRI was highly repeatable with CoVs averaged over all five volunteers of 1.9% ± 0.9% for NAWM and 2.2% ± 1.6% for NAGM. Average NAWM aTSC was significantly higher in patients with SPMS compared with the control group (p = 0.009). Average NAGM aTSC did not differ significantly between healthy volunteers and MS patients (p = 0.98). The proposed postprocessing pipeline shows high repeatability and the results can serve as a baseline for further studies establishing 23Na brain MRI as a biomarker in diseases such as MS.
CRIS-Team Scopus Importer:2022-08-19
Keywords: 7 T; brain MRI; multiple sclerosis

QUANTITATIVE ANALYSIS BY SODIUM AND PROTON BASED 3-TESLA MR IMAGING OF THE ACHILLES TENDON - Muller-Lutz, A.; Kamp, B.; Klein-Schmeink, L.; Tsiami, S.; Frenken, M.; Nagel, Armin Michael; Baraliakos, X.; Sewerin, P. (ANNALS OF THE RHEUMATIC DISEASES, 2022)
CRIS-Team WoS Importer:2022-11-04

Quantitative analysis of zirconia and titanium implant artefacts in three-dimensional virtual models of multi-slice CT and cone beam CT: does scan protocol matter? - Matta, Ragai; Knapp Giacaman, Stephanie; Wiesmüller, Marco; Lutz, Rainer; Uder, Michael; Wichmann, Manfred; Seidel, Anna (Dentomaxillofacial Radiology, 2023)
OBJECTIVES: Artefacts from dental implants in three-dimensional (3D) imaging may lead to incorrect representation of anatomical dimensions and impede virtual planning in navigated implantology. The aim of this study was quantitative assessment of artefacts in 3D STL models from cone beam CT (CBCT) and multislice CT (MSCT) using different scanning protocols and titanium-zirconium (Ti-Zr) and zirconium (ZrO2) implant materials. METHODS: Three ZrO2 and three Ti-Zr implants were respectively placed in the mandibles of two fresh human specimens. Before (baseline) and after implant placement, 3D digital imaging scans were performed (10 repetitions per timepoint: voxel size 0.2 mm³ and 0.3 mm³ for CBCT; 80 and 140 kV in MSCT). DICOM data were converted into 3D STL models and evaluated in computer-aided design software. After precise merging of the baseline and post-op models, the surface deviation was calculated, representing the extent of artefacts in the 3D models. RESULTS: Compared with baseline, ZrO2 emitted 36.5-37.3% (±0.6-0.8) artefacts in the CBCT and 39.2-50.2% (±0.5-1.2) in the MSCT models. Ti-Zr implants produced 4.1-7.1% (±0.3-3.0) artefacts in CBCT and 5.4-15.7% (±0.5-1.3) in MSCT. Significantly more artefacts were found in the MSCT vs CBCT models for both implant materials (p < 0.05). Significantly fewer artefacts were visible in the 3D models from scans with higher kilovolts in MSCT and smaller voxel size in CBCT. CONCLUSIONS: Among the four applied protocols, the lowest artefact proportion of ZrO2 and Ti-Zr implants in STL models was observed with CBCT and the 0.3 mm³ voxel size.
EVALuna2:541032

Quantitative and qualitative comparison of 4D-DSA with 3D-DSA using computational fluid dynamics simulations in cerebral aneurysms - Lang, Sabine; Birkhold, A. I.; Schmidt, Manuel; Endres, J.; Strother, C.; Dörfler, Arnd; Lücking, Hannes; Hölter, Philip (American Journal of Neuroradiology, 2019)
BACKGROUND AND PURPOSE: 4D-DSA allows time-resolved 3D imaging of the cerebral vasculature. The aim of our study was to evaluate this method in comparison with the current criterion standard 3D-DSA by qualitative and quantitative means using computational fluid dynamics. MATERIALS AND METHODS: 3D- and 4D-DSA datasets were acquired in patients with cerebral aneurysms. Computational fluid dynamics analysis was performed for all datasets. Using computational fluid dynamics, we compared 4D-DSA with 3D-DSA in terms of both aneurysmal geometry (quantitative: Maximum diameter, ostium size [OZ1/2], volume) and hemodynamic parameters (qualitative: Flow stability, flow complexity, inflow concentration; quantitative: Average/maximum wall shear stress, impingement zone, low-stress zone, intra-aneurysmal pressure, and flow velocity). Qualitative parameters were descriptively analyzed. Correlation coefficients (r, P value) were calculated for quantitative parameters. RESULTS: 3D- and 4D-DSA datasets of 10 cerebral aneurysms in 10 patients were postprocessed. Evaluation of aneurysmal geometry with 4D-DSA (rmaximum diameter = 0.98, Pmaximum diameter <.001; rOZ1/OZ2 = 0.98/0.86, POZ1/OZ2 =.001/.002; rvolume = 0.98, Pvolume <.001) correlated highly with 3D-DSA. Evaluation of qualitative hemodynamic parameters (flow stability, flow complexity, inflow concentration) did show complete accordance, and evaluation of quantitative hemodynamic parameters (raverage/maximum wall shear stress diastole=0.92/0.88, Paverage/maximum wall shear stress diastole <.001/.001; raverage/maximum wall shear stress systole = 0.94/0.93, Paverage/maximum wall shear stress systole < .001/.001; rimpingement zone=0.96, Pimpingement zone <.001; rlow-stress zone=1.00, Plow-stress zone <.01; rpressure diastole=0.84,Ppressure diastole< .002; rpressure systole=0.9, Ppressure systole <.001; rflow velocity diastole=0.95, Pflow velocity diastole <.001; rflow velocity systole=0.93,Pflow velocity systole <.001) did show nearly complete accordance between 4D- and 3D-DSA. CONCLUSIONS: Despite a different injection protocol, 4D-DSA is a reliable basis for computational fluid dynamics analysis of the intracranial vasculature and provides equivalent visualization of aneurysm geometry compared with 3D-DSA.
CRIS-Team Scopus Importer:2019-09-17

QUANTITATIVE ASSESSMENT AND ANALYSIS OF HAND MUSCLE VOLUME - Friedberger, Andreas; Figueiredo, C.; Museyko, Oleg; Grimm, Alexandra; D'Oliveira, I.; Bäuerle, Tobias; Rech, Jürgen; Chaudry, Oliver; Uder, Michael; Schett, Georg; Engelke, Klaus (2017)
EVALuna2:14726

Quantitative assessment of muscle injury by (23)Na magnetic resonance imaging - Dahlmann, Anke; Kopp, Christoph; Linz, Peter; Seuß, Hannes; Eckardt, Kai-Uwe; Luft, Friedrich C.; Titze, Jens; Uder, Michael; Hammon, Matthias; Cavallaro, Alexander Josef (SpringerPlus, 2016)
(23)Na magnetic resonance imaging ((23)Na-MRI) is able to measure Na(+) in vivo in humans and allows quantification of tissue sodium distribution. We now tested the utility of (23)Na-MRI technique in detecting and assessing sports-related acute muscular injury.We assessed tissue Na(+) of both lower legs with a 3T MRI scanner using a customized (23)Na knee coil. The affected left calf muscle in an injured volleyball player showed a hyperintense Na(+) signal. Follow-up measurements revealed persistently increased muscle Na(+) content despite complete clinical recovery.Our findings suggest that (23)Na-MRI could have utility in detecting subtle muscular injury and might indicate when complete healing has occurred. Furthermore, (23)Na-MRI suggests the presence of substantial injury-related muscle electrolyte shifts that warrant more detailed investigation.
EVALuna2:3865

Quantitative Corticospinal Tract Assessment in Acute Intracerebral Hemorrhage - Volbers, Bastian; Mennecke, Angelika; Kästle, Nicola; Huttner, Hagen; Schwab, Stefan; Schmidt, Manuel; Engelhorn, Tobias Martin; Dörfler, Arnd (Translational Stroke Research, 2020)
Intracerebral hemorrhage (ICH) prognostication during the acute phase is often subjective among physicians and often affects treatment decisions. The present study explores objective imaging parameters using quantitative corticospinal tract (CST) fiber reconstruction during the acute phase of ICH and correlates these parameters with functional outcome and patient recovery. We prospectively enrolled nonsurgical spontaneous supratentorial ICH patients and obtained an MRI scan on day 5 ± 1. Q-space diffeomorphic reconstruction was performed using DSI Studio, and quantitative anisotropy (QA) was calculated. The CST was reconstructed based on QA. The dichotomized modified Rankin Scale score on day 90 (favorable outcome = 0–2) and Barthel Index (favorable recovery = 100 on day 90 or improvement between discharge and day 90 > 60%) were assessed. Thirty-three patients, median age 72 years (interquartile range (IQR) 64–83), 21 female (64%), 21 (64%) with lobar hemorrhage, median ICH volume on admission 15.0 (IQR 7.0–27.4) mL, were included. Sixteen patients (48%) had a favorable outcome and 24 (73%) had a favorable recovery. The mean number of ipsilesional reconstructed CST fiber pathways was higher in patients with favorable outcomes (153 (standard deviation (SD) 103) vs. 60 (SD 39), p = 0.003) and predicted outcome after adjustment (Exp(B) = 1.016 (95% CI = 1.002–1.030)). QA in the ipsilesional posterior limb of the internal capsule showed a trend towards an association with favorable outcome (Exp(B) = 1.194 (95% CI = 0.991–1.439 (adjusted))). The total (ipsilesional + contralesional) number of reconstructed fiber pathways was associated with favorable recovery (Exp(B) = 1.025 (95% CI = 1.003–1.047 (adjusted))). Quantitative tractography parameters assessed in the acute phase of ICH may represent a promising predictor of long-term outcome and recovery. This might facilitate prognostic evaluation and organization of rehabilitation.
CRIS-Team Scopus Importer:2020-10-02
Keywords: All rehabilitation; DWI; Intracerebral hemorrhage; MRI; Outcome research

Quantitative CT of the knee in the IMI-APPROACH osteoarthritis cohort: Association of bone mineral density with radiographic disease severity, meniscal coverage and meniscal extrusion - Heiß, Rafael; Laredo, Jean Denis; Wirth, Wolfgang; Jansen, Mylène P.; Marijnissen, Anne C.A.; Lafeber, Floris; Lalande, Agnes; Weinans, Harrie H.; Blanco, Francisco J.; Berenbaum, Francis; Kloppenburg, Margreet; Haugen, Ida K.; et al. (Bone, 2023)
Objective: Osteoarthritis (OA) is a highly prevalent chronic condition. The subchondral bone plays an important role in onset and progression of OA making it a potential treatment target for disease-modifying therapeutic approaches. However, little is known about changes of periarticular bone mineral density (BMD) in OA and its relation to meniscal coverage and meniscal extrusion at the knee. Thus, the aim of this study was to describe periarticular BMD in the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort at the knee and to analyze the association with structural disease severity, meniscal coverage and meniscal extrusion. Design: Quantitative CT (QCT), MRI and radiographic examinations were acquired in 275 patients with knee osteoarthritis (OA). QCT was used to assess BMD at the femur and tibia, at the cortical bone plate (Cort) and at the epiphysis at three locations: subchondral (Sub), mid-epiphysis (Mid) and adjacent to the physis (Juxta). BMD was evaluated for the medial and lateral compartment separately and for subregions covered and not covered by the meniscus. Radiographs were used to determine the femorotibial angle and were evaluated according to the Kellgren and Lawrence (KL) system. Meniscal extrusion was assessed from 0 to 3. Results: Mean BMD differed significantly between each anatomic location at both the femur and tibia (p < 0.001) in patients with KL0. Tibial regions assumed to be covered with meniscus in patients with KL0 showed lower BMD at Sub (p < 0.001), equivalent BMD at Mid (p = 0.07) and higher BMD at Juxta (p < 0.001) subregions compared to regions not covered with meniscus. Knees with KL2–4 showed lower Sub (p = 0.03), Mid (p = 0.01) and Juxta (p < 0.05) BMD at the medial femur compared to KL0/1. Meniscal extrusion grade 2 and 3 was associated with greater BMD at the tibial Cort (p < 0.001, p = 0.007). Varus malalignment is associated with significant greater BMD at the medial femur and at the medial tibia at all anatomic locations. Conclusion: BMD within the epiphyses of the tibia and femur decreases with increasing distance from the articular surface. Knees with structural OA (KL2–4) exhibit greater cortical BMD values at the tibia and lower BMD at the femur at the subchondral level and levels beneath compared to KL0/1. BMD at the tibial cortical bone plate is greater in patients with meniscal extrusion grade 2/3.
CRIS-Team Scopus Importer:2023-01-20
Keywords: Bone mineral density; Knee; Multicenter study; Osteoarthritis; Quantitative CT

Quantitative dynamic oxygen 17 MRI at 7.0 T for the cerebral oxygen metabolism in glioma - Paech, Daniel; Nagel, Armin Michael; Schultheiss, Miriam N.; Umathum, Reiner; Regnery, Sebastian; Scherer, Moritz; Wick, Antje; Platt, Tanja; Wick, Wolfgang; Bendszus, Martin; Unterberg, Andreas; Schlemmer, Heinz-Peter; et al. (Radiology, 2020)
Background: Altered metabolism is a characteristic of cancer. Because of a shift in glucose metabolism from oxidative phosphorylation to lactate production for energy generation, malignant tumors are characterized by increased glycolysis followed by lactic acid fermentation, even in the presence of abundant oxygen (the Warburg effect). Purpose: To quantitatively investigate dynamic oxygen 17 (17O) MRI in healthy participants and participants with untreated glioma to understand altered cerebral oxygen metabolism in glioma. Materials and Methods: In this prospective study conducted from September 2016 to June 2018, individuals with newly diagnosed previously untreated glioma (World Health Organization grade II2IV) and healthy volunteers were included. Dynamic 17O MRI was performed with a 7.0-T whole-body system. 17O2 gas inhalation enabled dynamic measurement of the cerebral metabolic rate of oxygen (CMRO2) consumption. In healthy volunteers and participants with glioma, CMRO2 values in gray matter and white matter volumes were compared by using Wilcoxon signed rank tests. In participants with glioma, the tumor volume and tumor subcompartments were compared with normal-appearing gray matter and white matter by using Friedman test followed by Holm-Sidak post hoc tests. Results: Ten participants (mean age, 42 years 6 18 [standard deviation]; nine men) with glioma and three healthy volunteers (mean age, 44 years 6 21; all men) were evaluated. CMRO2 was higher in normal-appearing gray matter compared with white matter in both participants with glioma (2.36 mmol/g/min 6 0.22 vs 0.75 mmol/g/min 6 0.10, respectively) and healthy volunteers (2.38 mmol/g/min 6 0.15 vs 0.63 mmol/g/min 6 0.05, respectively) (P , .001 and P = .03, respectively). In the tumor region, CMRO2 was reduced (high-grade tumor CMRO2, 0.23 mmol/g/min 6 0.07; low-grade tumor CMRO2, 0.39 mmol/g/min 6 0.16; overall CMRO2, 0.34 mmol/g/min 6 0.16) compared with normal-appearing gray matter (P , .001) and normal-appearing white matter (P , .001) in accordance with the Warburg theorem. Conclusion: Dynamic oxygen 17 MRI method at 7.0 T as a direct metabolic imaging technique in glioma enabled quantitative visualization of the Warburg effect. A general reduction in oxidative glycolysis was observed in accordance with the Warburg theorem.
CRIS-Team Scopus Importer:2020-03-31

Quantitative Imaging in Muscle Diseases with Focus on Non-proton MRI and Other Advanced MRI Techniques - Weber, Marc-Andre; Nagel, Armin Michael; Kan, Hermien E.; Wattjes, Mike P. (Seminars in Musculoskeletal Radiology, 2020)
The role of neuromuscular imaging in the diagnosis of inherited and acquired muscle diseases has gained clinical relevance. In particular, magnetic resonance imaging (MRI), especially whole-body applications, is increasingly being used for the diagnosis and monitoring of disease progression. In addition, they are considered as a powerful outcome measure in clinical trials. Because many muscle diseases have a distinct muscle involvement pattern, whole-body imaging can be of diagnostic value by identifying this pattern and thus narrowing the differential diagnosis and supporting the clinical diagnosis. In addition, more advanced MRI applications including non-proton MRI, diffusion tensor imaging, perfusion MRI, T2 mapping, and magnetic resonance spectroscopy provide deeper insights into muscle pathophysiology beyond the mere detection of fatty degeneration and/or muscle edema. In this review article, we present and discuss recent data on these quantitative MRI techniques in muscle diseases, with a particular focus on non-proton imaging techniques.
CRIS-Team WoS Importer:2020-10-16

Quantitative imaging of apoptosis following oncolytic virotherapy by magnetic resonance fingerprinting aided by deep learning - Perlman, Or; Ito, Hirotaka; Herz, Kai; Shono, Naoyuki; Nakashima, Hiroshi; Zaiß, Moritz; Chiocca, E. Antonio; Cohen, Ouri; Rosen, Matthew S.; Farrar, Christian T. (Nature Biomedical Engineering, 2021)
Non-invasive imaging methods for detecting intratumoural viral spread and host responses to oncolytic virotherapy are either slow, lack specificity or require the use of radioactive or metal-based contrast agents. Here we show that in mice with glioblastoma multiforme, the early apoptotic responses to oncolytic virotherapy (characterized by decreased cytosolic pH and reduced protein synthesis) can be rapidly detected via chemical-exchange-saturation-transfer magnetic resonance fingerprinting (CEST-MRF) aided by deep learning. By leveraging a deep neural network trained with simulated magnetic resonance fingerprints, CEST-MRF can generate quantitative maps of intratumoural pH and of protein and lipid concentrations by selectively labelling the exchangeable amide protons of endogenous proteins and the exchangeable macromolecule protons of lipids, without requiring exogenous contrast agents. We also show that in a healthy volunteer, CEST-MRF yielded molecular parameters that are in good agreement with values from the literature. Deep-learning-aided CEST-MRF may also be amenable to the characterization of host responses to other cancer therapies and to the detection of cardiac and neurological pathologies.
CRIS-Team Scopus Importer:2021-11-19

QUANTITATIVE MAGNETIC RESONANCE IMAGING CORRELATES WITH EARLY S100B PROFILE AND FUNCTIONAL OUTCOME AFTER ACUTE BRAIN INJURY - Roeckelein, Verena; Kloska, Stephan; Uder, Michael; Buchfelder, Michael; Kleindienst, Andrea (2016)
EVALuna2:14588

Quantitative measurement of cartilage morphology in osteoarthritis: current knowledge and future directions - Wirth, Wolfgang; Ladel, Christoph; Maschek, Susanne; Wisser, Anna; Eckstein, Felix; Roemer, Frank (Skeletal Radiology, 2022)
Quantitative measures of cartilage morphology (“cartilage morphometry”) extracted from high resolution 3D magnetic resonance imaging (MRI) sequences have been shown to be sensitive to osteoarthritis (OA)-related change and also to treatment interventions. Cartilage morphometry is therefore nowadays widely used as outcome measure for observational studies and randomized interventional clinical trials. The objective of this narrative review is to summarize the current status of cartilage morphometry in OA research, to provide insights into aspects relevant for the design of future studies and clinical trials, and to give an outlook on future developments. It covers the aspects related to the acquisition of MRIs suitable for cartilage morphometry, the analysis techniques needed for deriving quantitative measures from the MRIs, the quality assurance required for providing reliable cartilage measures, and the appropriate participant recruitment criteria for the enrichment of study cohorts with knees likely to show structural progression. Finally, it provides an overview over recent clinical trials that relied on cartilage morphometry as a structural outcome measure for evaluating the efficacy of disease-modifying OA drugs (DMOAD).
CRIS-Team Scopus Importer:2022-11-25
Keywords: Cartilage loss; Knee; MRI; Osteoarthritis

Quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis - data from the Osteoarthritis Initiative - Emmanuel, K.; Quinn, E.; Niu, J.; Guermazi, Ali; Roemer, Frank; Wirth, Wolfgang; Eckstein, F.; Felson, D. (Osteoarthritis and Cartilage, 2016)
To test the hypothesis that quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis (KOA), prior to the advent of radiographic disease.206 knees with incident radiographic KOA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline, developing KLG 2 or greater with a definite osteophyte and joint space narrowing (JSN) grade >=1 by year 4) were matched to 232 control knees not developing incident KOA. Manual segmentation of the central five slices of the medial and lateral meniscus was performed on coronal 3T DESS MRI and quantitative meniscus position was determined. Cases and controls were compared using conditional logistic regression adjusting for age, sex, BMI, race and clinical site. Sensitivity analyses of early (year [Y] 1/2) and late (Y3/4) incidence was performed.Mean medial extrusion distance was significantly greater for incident compared to non-incident knees (1.56 mean ± 1.12 mm SD vs 1.29 ± 0.99 mm; +21%, P < 0.01), so was the percent extrusion area of the medial meniscus (25.8 ± 15.8% vs 22.0 ± 13.5%; +17%, P < 0.05). This finding was consistent for knees restricted to medial incidence. No significant differences were observed for the lateral meniscus in incident medial KOA, or for the tibial plateau coverage between incident and non-incident knees. Restricting the analysis to medial incident KOA at Y1/2 differences were attenuated, but reached significance for extrusion distance, whereas no significant differences were observed at incident KOA in Y3/4.Greater medial meniscus extrusion predicts incident radiographic KOA. Early onset KOA showed greater differences for meniscus position between incident and non-incident knees than late onset KOA.
EVALuna2:14525

Quantitative MR-Bildgebung zur Charakterisierung der Skelettmuskulatur - Engelke, Klaus; Chaudry, Oliver; Nagel, Armin Michael (Osteologie, 2020)
This article provides an overview of magnetic resonance imaging (MRI) based methods for the quantification of muscle degeneration. In addition to muscle volume, Dixon imaging can be used to determine the percentage of fat. In addition, there are approaches to visualize and quantify early signs of degeneration via the distribution of the degree of inflammation or the sodium concentration of the muscle. Except for sodium imaging, these methods are routinely used for diagnosis and follow-up in muscle diseases. In osteology and gerontology, the importance of the muscle-bone unit for fracture prediction and frailty in old age is routinely emphasized, but degeneration of the muscles is mainly recorded via extrinsic parameters such as muscle strength and function. Frequently used intrinsic parameters such as DXA lean mass or muscle volume determined with CT or MRI correlate only moderately with extrinsic parameters. However, a more precise characterization of muscle quality should remedy this shortcoming. Appropriate methods are available with CT and MRI, but these must now be used in studies on age-related muscle degeneration, in intervention studies and in studies on fracture risk assessment.
CRIS-Team Scopus Importer:2020-06-16
Keywords: adipose tissue; bone muscle unit; Dixon; inflammation; magnetic resonant imaging; Muscle

Quantitative susceptibility mapping and 23 Na imaging-based in vitro characterization of blood clotting kinetics - Schneider, Till M.; Nagel, Armin Michael; Zorn, Markus; Wetscherek, Andreas; Bendszus, Martin; Ladd, Mark E.; Straub, Sina (NMR in Biomedicine, 2018)
Blood clotting is a fundamental biochemical process in post-hemorrhagic hemostasis. Although the varying appearance of coagulating blood in T1 - and T2 -weighted images is widely used to qualitatively determine bleeding age, the technique permits only a rough discrimination of coagulation stages, and it remains difficult to distinguish acute and chronic hemorrhagic stages because of low T1 - and T2 -weighted signal intensities in both instances. To investigate new biomedical parameters for magnetic resonance imaging-based characterization of blood clotting kinetics, sodium imaging and quantitative susceptibility mapping (QSM) were compared with conventional T1 - and T2 -weighted imaging, as well as with biochemical hemolysis parameters. For this purpose, a blood-filled spherical agar phantom was investigated daily for 14 days, as well as after 24 days at 7 T after initial preparation with fresh blood. T1 - and T2 -weighted sequences, a three-dimensional (3D) gradient echo sequence and a density-adapted 3D radial projection reconstruction pulse sequence for 23 Na imaging were applied. For hemolysis estimations, free hemoglobin and free potassium concentrations were measured photometrically and with the direct ion-selective electrode method, respectively, in separate heparinized whole-blood samples along the same timeline. Initial mean susceptibility was low (0.154 ± 0.020 ppm) and increased steadily during the course of coagulation to reach up to 0.570 ± 0.165 ppm. The highest total sodium (NaT) values (1.02 ± 0.06 arbitrary units) in the clot were observed initially, dropped to 0.69 ± 0.13 arbitrary units after one day and increased again to initial values. Compartmentalized sodium (NaS) showed a similar signal evolution, and the NaS/NaT ratio steadily increased over clot evolution. QSM depicts clot evolution in vitro as a process associated with hemoglobin accumulation and transformation, and enables the differentiation of the acute and chronic coagulation stages. Sodium imaging visualizes clotting independent of susceptibility and seems to correspond to clot integrity. A combination of QSM and sodium imaging may enhance the characterization of hemorrhage.
EVALuna2:36249

Quantitative susceptibility mapping depicts severe myelin deficit and iron deposition in a transgenic model of multiple system atrophy - Lambrecht, Vera; Hanspach, Jannis; Hoffmann, Alana; Seyler, Lisa; Mennecke, Angelika; Straub, Sina; Marxreiter, Franz; Bäuerle, Tobias; Winkler, Jürgen; Laun, Frederik Bernd (Experimental Neurology, 2020)
Despite internationally established diagnostic criteria, multiple system atrophy (MSA) is frequently misdiagnosed, particularly at disease onset. While neuropathological changes such as demyelination and iron deposition are typically detected in MSA, these structural hallmarks were so far only demonstrated post-mortem. Here, we examine whether myelin deficit observed in a transgenic murine model of MSA can be visualized and quantified in vivo using specific magnetic resonance imaging (MRI) approaches. Reduced myelin content was measured histologically in prototypical white matter as well as mixed grey-white matter regions i.e. corpus callosum, anterior commissure, and striatum of transgenic mice overexpressing human α-synuclein under the control of the myelin basic protein promotor (MBP29-hα-syn mice). Correspondingly, in vivo quantitative susceptibility mapping (QSM) showed a strongly reduced susceptibility contrast in white matter regions and T2-weighted MR imaging revealed a significantly reduced grey-white matter contrast in MBP29-hα-syn mice. In addition, morphological analysis suggested a pronounced, white matter-specific deposition of iron in MBP29-hα-syn mice. Importantly, in vivo MRI results were matched by comprehensive structural characterization of myelin, iron, and axonal directionality. Taken together, our results provide strong evidence that QSM is a very sensitive tool measuring changes in myelin density in conjunction with iron deposition in MBP29-hα-syn mice. This multimodal neuroimaging approach may pave the way towards a novel non-invasive technique to detect crucial neuropathological changes specifically associated with MSA.
CRIS-Team Scopus Importer:2020-04-28
Keywords: Iron; Multiple system atrophy; Myelin imaging; Quantitative susceptibility mapping; White matter

Quantitative T2 Mapping Shows Increased Degeneration in Adjacent Intervertebral Discs Following Kyphoplasty - Pachowsky, Milena; Kleyer, Arnd; Wagner, Lisa; Langenbach, Andreas; Simon, David; Janka, Rolf Matthias; May, Matthias; Welsch, Goetz H. (Cartilage, 2018)
Objective A minimally invasive treatment of osteoporotic and nonosteoporotic thoracic and lumbar spine fractures is cement augmentation (kyphoplasty). Little is known about the impact on adjacent intervertebral discs. A quantitative magnetic resonance imaging (MRI) approach in addition to morphological MRI is desirable to evaluate changes in the intervertebral disc. Our study aims to evaluate the feasibility of T2 mapping for the detection of subtle changes in the intervertebral discs in spines after kyphoplasty. Design Intervertebral discs were assessed by quantitative MRI (3.0 T) using T2 relaxation time mapping. Region of interest (ROI; 6 per disc) analyses were performed. The ROIs at the anterior and posterior edges were interpreted as annulus fibrosus (AF). The 2 very inner zones were regarded as nucleus pulposus (NP) and the regions in between as intermediate transition zone. We compared T2 relaxation time values of intervertebral discs adjacent to the vertebrae after kyphoplasty with those nonadjacent to vertebrae after kyphoplasty, especially in the NP. Results The analysis of the ROIs showed that the intervertebral discs of the adjacent vertebral segments are associated with reduced T2 values compared to those that are nonadjacent to the affected vertebrae. Conclusion This study is to our knowledge the first investigation of intervertebral discs after kyphoplasty by quantitative MRI. Quantitative T2 mapping shows increased degeneration in adjacent intervertebral discs following kyphoplasty. Besides its contribution to a broader knowledge of postoperative changes after kyphoplasty, our findings may help to improve differentiation between healthy and degenerated intervertebral discs using these techniques.
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Quiet diffusion-weighted head scanning: Initial clinical evaluation in ischemic stroke patients at 1.5T - Rösch, Julie; Ott, Martin; Heismann, Bjoern; Dörfler, Arnd; Engelhorn, Tobias; Sembritzki, Klaus; Grodzki, David M. (Journal of Magnetic Resonance Imaging, 2016)
PURPOSE: To compare the quality and diagnostic value of routine single-shot, echo-planar imaging, diffusion-weighted imaging (ss-EPI-DWI) to those of quiet readout segmented EPI-DWI (q-DWI) in magnetic resonance imaging (MRI) of acute stroke. MATERIALS AND METHODS: Twenty-six patients with acute stroke underwent a 1.5T MRI including diffusion-weighted ss-EPI and q-DWI. The two sequences were protocolled to have identical spatial resolution and spatial coverage. q-DWI was tested with (regular q-DWI) and without (fast q-DWI) averaging in 13 patients each. The acoustic noise generated by each sequence was measured. Quantitative and qualitative assessments regarding signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), lesion conspicuity, level of artifacts, overall image quality as well as diagnostic content were performed. RESULTS: SNR and CNR values of the q-DWI scans were considerably higher than those of ss-EPI DWI (P ≤ 0.0078). No statistical difference was found for lesion conspicuity (P ≥ 0.125). Statistical differences were found for level of artifacts (P ≥ 0.0078) and overall image quality (P ≥ 0.002). Both were evaluated better in the ss-EPI DWI than in the regular and fast q-DWI. Apart from one fast q-DWI patient, radiologists voted the images to have the same diagnostic content, with upper 90% confidence limits of 0.238 for regular q-DWI and 0.429 for fast q-DWI. CONCLUSION: If the acoustic burden is critical to the patient, q-DWI is an equivalent quiet alternative to ss-EPI DWI for use in stroke patients. J. Magn. Reson. Imaging 2016;44:1238-1243.
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Quiet FLAIR at 7T MRI - Rösch, Julie; Mennecke, Angelika; Knott, Michael; Dörfler, Arnd; Grodzki, David M. (Investigative Radiology, 2020)
OBJECTIVE: The aim of this study was to investigate acoustic noise reduction and image quality of cranial magnetic resonance imaging (MRI) at 7T MRI with and without sequence-based acoustic noise reduction. MATERIALS AND METHODS: Fifteen patients and 5 healthy volunteers underwent 7T MRI scanning. A fluid-attenuated inversion recovery (FLAIR) sequence was acquired with and without sequence-based acoustic noise reduction. The acoustic noise generated by each sequence was measured. Quantitative and qualitative assessments regarding signal-to-noise ratio, contrast-to-noise ratio, lesion conspicuity, level of artifacts, and overall image quality were performed. Furthermore, detection rates of white matter lesions were evaluated by 2 observers for both sequences. RESULTS: Acoustic noise was significantly reduced from initially 92.7 dB(A) to 78.9 dB(A), corresponding to an 80% reduction in sound pressure. The visual assessment revealed no significant difference in the level of artifacts. Although rated very high by both readers, lesion conspicuity and image quality averaged better for the regular FLAIR sequence. Signal-to-noise ratio and contrast-to-noise ratio slightly decreased when applying the sequence-based acoustic noise reduction. No significant difference was found between the detection rates of white matter lesions for both observers. CONCLUSIONS: Reducing sound pressure by 80% in FLAIR imaging at 7T ultra-high-field MRI is feasible while maintaining high diagnostic image quality.
CRIS-Team Scopus Importer:2020-10-23

Radiation dose in cerebral angiography and flat detector CT applications in neuroradiology - Struffert, Tobias; Lang, Sabine; Scholz, R.; Hauer, M.; Dörfler, Arnd (Radiologe, 2015)
Flat detectors (FD) have completely replaced image intensifiers in angiography. Due to this development not only the image quality of 2D digital subtraction angiography series (2-D-DSA) could be improved but also the acquisition of computed tomography (CT)-like cross-sectional images (FD-CT) within the angio suite became feasible. These techniques are now being used in daily clinical routine. Only little information about effective doses of these applications to patients has been published in the literature. We describe the effective patient dose of current applications in the field of angiography and demonstrate strategies to minimize the dose to the patient. In addition, we compare FD-CT applications to standard multislice CT applications.
EVALuna2:22998

Radiation dose reduction in parasinus CT by spectral shaping - May, Matthias; Brand, Michael; Lell, Michael; Sedlmair, Martin; Allmendinger, Thomas; Uder, Michael; Wüst, Wolfgang (Neuroradiology, 2017)
Spectral shaping aims to narrow the X-ray spectrum of clinical CT. The aim of this study was to determine the image quality and the extent of radiation dose reduction that can be achieved by tin prefiltration for parasinus CT.All scans were performed with a third generation dual-source CT scanner. A study protocol was designed using 100 kV tube voltage with tin prefiltration (200 mAs) that provides image noise levels comparable to a low-dose reference protocol using 100 kV without spectral shaping (25 mAs). One hundred consecutive patients were prospectively enrolled and randomly assigned to the study or control group. All patients signed written informed consent. The study protocol was approved by the local Institutional Review Board and applies to the HIPAA. Subjective and objective image quality (attenuation values, image noise, and contrast-to-noise ratio (CNR)) were assessed. Radiation exposure was assessed as volumetric CT dose index, and effective dose was estimated. Mann-Whitney U test was performed for radiation exposure and for image noise comparison.All scans were of diagnostic image quality. Image noise in air, in the retrobulbar fat, and in the eye globe was comparable between both groups (all p > 0.05). CNReye globe/air did not differ significantly between both groups (p = 0.7). Radiation exposure (1.7 vs. 2.1 mGy, p < 0.01) and effective dose (0.055 vs. 0.066 mSv, p < 0.01) were significantly reduced in the study group.Radiation dose can be further reduced by 17% for low-dose parasinus CT by tin prefiltration maintaining diagnostic image quality.
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Radiation Induced DNA Double-Strand Breaks in Radiology - Kuefner, M. A.; Brand, Michael; Engert, C.; Schwab, S. A.; Uder, Michael (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2015)
Shortly after the discovery of X-rays, their damaging effect on biological tissues was observed. The determination of radiation exposure in diagnostic and interventional radiology is usually based on physical measurements or mathematical algorithms with standardized dose simulations. ?-H2AX immunofluorescence microscopy is a reliable and sensitive method for the quantification of radiation induced DNA double-strand breaks (DSB) in blood lymphocytes. The detectable amount of these DNA damages correlates well with the dose received. However, the biological radiation damage depends not only on dose but also on other individual factors like radiation sensitivity and DNA repair capacity. Iodinated contrast agents can enhance the x-ray induced DNA damage level. After their induction DSB are quickly repaired. A protective effect of antioxidants has been postulated in experimental studies. This review explains the prinicple of the ?-H2AX technique and provides an overview on studies evaluating DSB in radiologic examinations.Radiologic examinations including CT and angiography induce DNA double-strand breaks. Even after mammography a slight but significant increase is detectable in peripheral blood lymphocytes. The number of radiation induced double-strand breaks correlates well with the radiation dose. Individual factors including radiation sensitivity, DNA repair capacity and the application of iodinated contrast media has an influence on the DNA damage level.
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Radiation protection in interventional radiology - Adamus, R.; Loose, Reinhard; Wucherer, M.; Uder, Michael; Galster, M. (Radiologe, 2016)
The application of ionizing radiation in medicine seems to be a safe procedure for patients as well as for occupational exposition to personnel. The developments in interventional radiology with fluoroscopy and dose-intensive interventions require intensified radiation protection. It is recommended that all available tools should be used for this purpose. Besides the options for instruments, x-ray protection at the intervention table must be intensively practiced with lead aprons and mounted lead glass. A special focus on eye protection to prevent cataracts is also recommended. The development of cataracts might no longer be deterministic, as confirmed by new data; therefore, the International Commission on Radiological Protection (ICRP) has lowered the threshold dose value for eyes from 150 mSv/year to 20 mSv/year. Measurements show that the new values can be achieved by applying all X-ray protection measures plus lead-containing eyeglasses.
EVALuna2:14607

Radiographically normal knees with contralateral joint space narrowing display greater change in cartilage transverse relaxation time than those with normal contralateral knees: a model of early OA? – data from the Osteoarthritis Initiative (OAI) - Wirth, W.; Maschek, S.; Roemer, Frank; Sharma, L.; Duda, G. N.; Eckstein, F. (Osteoarthritis and Cartilage, 2019)
Objective: To develop a model of early osteoarthritis, by examining whether radiographically normal knees with contralateral joint space narrowing (JSN), but without contralateral trauma history, display greater longitudinal cartilage composition change (transverse relaxation time; T2) than subjects with bilaterally normal knees. Methods: 120 radiographically normal knees (Kellgren Lawrence grade [KLG] 0) from the Osteoarthritis Initiative were studied. 60 case knees displayed definite contralateral radiographic knee osteoarthritis (KLG ≥ 2) whereas 60 reference subjects were bilaterally KLG0, and were matched 1:1 to cases based on age, sex, and BMI. All had multi-echo spin-echo MRI acquired at year (Y) 1 and 4 follow-up, with cartilage T2 being determined in superficial and deep cartilage layers across 16 femorotibial subregions. T2 across all regions was considered the primary analytic focus. Results: Of 60 KLG0 case knees (30 female, age: 65.0 ± 8.8 y, BMI: 27.6 ± 4.4 kg/m2), 21/22/13/4 displayed contralateral JSN 0/1/2/3, respectively. The longitudinal increase in the deep layer cartilage T2 between Y1 and Y4 was significantly greater (P = 0.03; Cohen's D 0.50) in the 39 KLG0 case knees with contralateral JSN (1.2 ms; 95% confidence interval [CI] [0.4, 2.0]) than in matched KLG0 reference knees (0.1 ms; 95% CI [−0.5, 0.7]). No significant differences were identified in superficial T2 change. T2 at Y1 was significantly greater in case than in reference knees, particularly in the superficial layer of the medial compartment. Conclusions: Radiographically normal knees with contralateral, non-traumatic JSN represent an applicable model of early osteoarthritis, with deep layer cartilage composition (T2) changing more rapidly than in bilaterally normal knees. Clinicaltrials.gov identification: NCT00080171.
CRIS-Team Scopus Importer:2019-09-03
Keywords: Cartilage composition; Cartilage T2; Cartilage transverse relaxation time; Model of early osteoarthritis; MRI

Radiographic Exclusionary Findings During Screening for Three Phase III Trials of Subcutaneous Tanezumab in Patients with Moderate to Severe Hip or Knee Osteoarthritis - Guermazi, Ali; Roemer, Frank; Kompel, Andrew; Diaz, Luis; Crema, Michel; Brown, Mark; Hickman, Anne; Pixton, Glenn; Viktrup, Lars; Fountaine, Robert; Burr, Aimee; Sherlock, Sarah; et al. (ARTHRITIS & RHEUMATOLOGY, 2020)
CRIS-Team WoS Importer:2021-01-15

Radiologische Diagnostik zerebraler Metastasen - Engelhorn, Tobias; et al. (Onkologe, 2014)
Background. Imaging plays a key role in the diagnosis of central nervous system (CNS) metastases. Objective. In this review the role of magnetic resonance imaging (MRI) and computed tomography (CT) in the work-up of cerebral metastases is presented. In addition to characteristic imaging findings technical aspects for improved detection of CNS metastases and differential diagnoses are shown. Material and methods. This review is based on own experience and relevant recent publications. Results. In the diagnosis of CNS metastases contrast-enhanced MRI is the radiological method of choice. The sensitivity can be further increased by increasing contrast medium dose as well as the use of various magnetization transfer techniques. Functional MRI techniques, such as magnetic resonance spectroscopy, perfusion and diffusion-weighted imaging, diffusion tensor imaging and dynamic contrast-enhanced imaging can further improve the differential diagnosis and detection of recurrent disease. If CT is used for diagnostics of cerebral metastases it should be performed with increased contrast combined with a scan delay. Conclusions. Contrast-enhanced MRI ideally using a multimodal protocol is the most sensitive method for the detection of CNS metastases and should therefore be preferred to CT. © 2013 Springer-Verlag Berlin Heidelberg.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Brain; Computed tomography; Contrast medium; Magnetic resonance imaging; Metastasis

Radiomics Based on Adapted Diffusion Kurtosis Imaging Helps to Clarify Most Mammographic Findings Suspicious for Cancer - Bickelhaupt, Sebastian; Jaeger, Paul Ferdinand; Lederer, Wolfgang; Daniel, Heidi; Kuder, Tristan Anselm; Wuesthof, Lorenz; Paech, Daniel; Bonekamp, David; Radbruch, Alexander; Delorme, Stefan; Schlemmer, Heinz-Peter; Steudle, Franziska Hildegard; et al. (Radiology, 2018)
Purpose To evaluate a radiomics model of Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 breast lesions extracted from breast-tissue-optimized kurtosis magnetic resonance (MR) imaging for lesion characterization by using a sensitivity threshold similar to that of biopsy. Materials and Methods This institutional study included 222 women at two independent study sites (site 1: training set of 95 patients; mean age ± standard deviation, 58.6 years ± 6.6; 61 malignant and 34 benign lesions; site 2: independent test set of 127 patients; mean age, 58.2 years ± 6.8; 61 malignant and 66 benign lesions). All women presented with a finding suspicious for cancer at x-ray mammography (BI-RADS 4 or 5) and an indication for biopsy. Before biopsy, diffusion-weighted MR imaging (b values, 0-1500 sec/mm2) was performed by using 1.5-T imagers from different MR imaging vendors. Lesions were segmented and voxel-based kurtosis fitting adapted to account for fat signal contamination was performed. A radiomics feature model was developed by using a random forest regressor. The fixed model was tested on an independent test set. Conventional interpretations of MR imaging were also assessed for comparison. Results The radiomics feature model reduced false-positive results from 66 to 20 (specificity 70.0% [46 of 66]) at the predefined sensitivity of greater than 98.0% [60 of 61] in the independent test set, with BI-RADS 4a and 4b lesions benefiting from the analysis (specificity 74.0%, [37 of 50]; 60.0% [nine of 15]) and BI-RADS 5 lesions showing no added benefit. The model significantly improved specificity compared with the median apparent diffusion coefficient (P < .001) and apparent kurtosis coefficient (P = .02) alone. Conventional reading of dynamic contrast material-enhanced MR imaging provided sensitivity of 91.8% (56 of 61) and a specificity of 74.2% (49 of 66). Accounting for fat signal intensity during fitting significantly improved the area under the curve of the model (P = .001). Conclusion A radiomics model based on kurtosis diffusion-weighted imaging performed by using MR imaging machines from different vendors allowed for reliable differentiation between malignant and benign breast lesions in both a training and an independent test data set. © RSNA, 2018 Online supplemental material is available for this article.
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Radiomics in diffusion data: a test–retest, inter- and intra-reader DWI phantom study - Dreher, C.; Kuder, T. A.; König, F.; Mlynarska-Bujny, A.; Tenconi, C.; Paech, D.; Schlemmer, H. P.; Ladd, M. E.; Bickelhaupt, Sebastian (Clinical Radiology, 2020)
AIM: The aim of this study was to evaluate the robustness of radiomics features of a MRI (magnetic resonance imaging) phantom in quantitative diffusion-weighted imaging (DWI) and depending on the image resolution. MATERIALS AND METHODS: Scanning of an in-house developed DWI phantom was performed at a 1.5 T MRI scanner (Magnetom AERA, Siemens, Erlangen, Germany) using an echo planar imaging (EPI) DWI sequence (b=0,500,1,000 s/mm2) with low (3×3 mm2) and high (2×2 mm2) image resolutions. Scans were repeated after phantom repositioning to evaluate retest reliability. Radiomics features were extracted after semi-automatic segmentation and standardised pre-processing. Intra-/interobserver reproducibility and test–retest robustness were assessed using intraclass correlation coefficients (ICC). Differences were tested with non-parametric Wilcoxon's signed-rank and Friedman's test (p < 0.05) with Dunn's post-hoc analysis. RESULTS: Test–retest ICC was overall high with >0.90 for 39/46 radiomics features in all sequences/resolutions. Decreased test–retest ICCs were pronounced for conventional Min-value (overall ICC=0.817), and grey-level zone length matrix (GLZLM) features Short-Zone Emphasis (SZE) and Short-Zone Low Grey-level Emphasis (SZLGE) (for both overall ICC=0.927). Test–retest reproducibility was significantly different between b=500, 1,000 and apparent diffusion coefficient (ADC) (mean 0.975±0.050, 0.974±0.051 and 0.966±0.063), which remained significant after post-hoc analysis between b=1,000 and ADC (p = 0.022). ICCs were not significantly different between resolutions of 2×2 and 3×3 mm2 regarding b=500 (mean: 0.977±0.052 and 0.974±0.049, p = 0.612), b=1,000 (mean: 0.973±0.059 and 0.974±0.054, p = 0.516), and ADC (mean: 0.972±0.049 and 0.955±0.101, p = 0.851). Inter- and intra-observer reliability was consistently high for all sequences (overall mean 0.992±0.021 and 0.990±0.028). CONCLUSION: Under ex-vivo conditions, DWI provided robust radiomics features with those from ADC being slightly less robust than from raw DWI (b=500, 1,000 s/mm2). No significant difference was detected for different resolutions. Although, ex-vivo reliability of DWI radiomics features was high, no implications can be made regarding in-vivo analyses.
CRIS-Team Scopus Importer:2020-08-07

Radiopacity of intracerebral hemorrhage correlates with perihemorrhagic edema - Wagner, Irina; Volbers, Bastian; Hilz, Max-Josef; Schwab, Stefan; Staykov, Dimitre; Dörfler, Arnd (European Journal of Neurology, 2012)
Background: Experimental evidence indicates that iron plays a key role in edema formation after intracerebral hemorrhage (ICH). We investigated the relationship between ICH radiopacity on CT as a marker of hematoma iron content and perihemorrhagic edema (PHE) after ICH. Methods: We retrospectively investigated patients with spontaneous lobar and ganglionic supratentorial ICH who received follow-up CT scans during the first 7days after symptom onset (d1, d2-4, d5-7). Measurements of ICH and edema volumes were taken using a semiautomatic threshold-based volumetric algorithm. Radiopacity of the blood clot was determined using the mean Hounsfield unit (HU) count of the ICH. Results: A total of 117 patients aged 71.92±11.55years with spontaneous ICH (34.63±32.44ml) were included in the analysis. Mean ICH radiopacity was 59.7±3.4HU. We found significantly larger relative PHE at d2-4 (1.7±0.9 vs. 1.3±0.8; P=0.032) and d5-7 (2.0±1.3 vs. 1.3±0.9; P=0.007) and larger peak relative PHE (2.3±1.6 vs. 1.6±1.1; P=0.006) in patients with ICH radiopacity >60HU (n=59), as compared to patients with ICH radiopacity <60HU (n=58). Conclusions: Higher ICH radiopacity, reflecting higher in vivo hematoma iron content, is associated with more PHE after ICH. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Intracerebral hemorrhage; Perihemorrhagic edema; Radiopacity

Radiostereometric migration measurement of an uncemented Cerafit® femoral stem: 26 patients followed for 10 years - Sesselmann, Stefan; Hong, Yutong; Schlemmer, Frank; Hussnaetter, Isabell; Müller, Lutz Arne; Forst, Raimund; Tschunko, Franz (Biomedizinische Technik, 2017)
Radiostereometric analysis (RSA) is the gold standard for evaluating micromotions of orthopaedic implants. The method is applied for identifying novel design weaknesses in endoprostheses. Current research frequently assesses relatively short time periods. Short-term RSA studies have been widely used for predicting the long-term stability of many hip prosthetic designs, but only a few studies have focused on uncemented hip implants, especially for extended periods. The purpose of this study was to analyse the migration pattern of the Cerafit® femoral stem within 10 years and to verify the predictive value of short-term RSA after 2 years for this uncemented femoral hip stem. Twenty-six patients were followed for 10 years. Ten years after implantation, a mean subsidence of 0.22 mm±0.56 mm, a mean internal rotation of 0.59°±1.67° and a mean maximum total point motion (MTPM) of 1.28 mm±0.54 mm were detected. The main migration took place in the first 6 weeks after surgery (subsidence of 0.36 mm±0.73 mm; internal rotation of 0.62°±1.49°, MTPM of 1.05 mm±0.68 mm). All the migration values measured were small. No late-onset migration was observed. This study suggests that the Cerafit® implants are stable after 10 years. Thus, RSA could be the best tool to assess long-term implant behaviour.
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Rapidly fatal SMARCA4-deficient undifferentiated sarcoma originating from hybrid hemosiderotic fibrolipomatous tumor/pleomorphic hyalinizing angiectatic tumor of the foot - Agaimy, Abbas; Meidenbauer, Norbert; Sukov, William R.; Stöhr, Robert; Vieth, Michael; Roemer, Frank; Grützmann, Robert; Folpe, Andrew L. (Virchows Archiv, 2021)
Pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts and hemosiderotic fibrolipomatous tumor (HFLT) are two rare low-grade locally recurring neoplasms with predilection for the foot/ankle. Recent studies support a close link between the two entities, and origin of PHAT from HFLT and occurrence of hybrid HFLT/PHAT have been documented. Both lesions often harbor TGFBR3 or MGEA5 rearrangements. Rare sarcomas originating from HFLT/PHAT have been reported, typically resembling myxofibrosarcoma or myxoinflammatory fibroblastic sarcoma. We describe a novel SMARCA4-deficient undifferentiated sarcoma with rhabdoid features originating from hybrid HFLT/PHAT in the foot of a 54-year-old male. The tumor pursued a highly aggressive course with rapid regrowth after resection and multiple metastases resulting in patient's death within 5 months, despite systemic chemotherapy. Immunohistochemistry revealed SMARCA4 loss in the undifferentiated sarcoma, but not in the HFLT/PHAT. Molecular testing confirmed TGFBR3/MGEA5 rearrangements. This report expands the phenotypes of sarcomas developing from pre-existing PHAT/HFLT.
CRIS-Team WoS Importer:2021-08-27

Rare intronic mutation between Exon 62 and 63 (c.9225–285A>G) of the dystrophin gene associated with atypical BMD phenotype - Schüssler, S. C.; Gerhalter, T.; Abicht, A.; Müller-Felber, W.; Nagel, Armin Michael; Trollmann, Regina (Neuromuscular Disorders, 2020)
Dystrophinopathies are predominantly caused by deletions, duplications and point mutations in the coding regions of the dystrophin gene with less than 1% of all pathogenic mutations identified within intronic sequences. We describe a 17-year-old male with a Becker muscular dystrophy diagnosis and mental disability due to an intron mutation that led to aberrant splicing and formation of an additional exon. Histopathological analysis of muscle tissue revealed signs of muscular dystrophy and reduced signal for dystrophin, alpha-sarcoglycan, and alpha-dystroglycan. Multiplex ligation-dependent probe amplification screening and total sequencing of the dystrophin gene did not identify a mutation in the coding regions. However, next generation sequencing revealed an intron mutation between exons 62 and 63 of the dystrophin gene known for pseudoexon formation and disruption of the reading frame. We report a functional consequence of this mutation as an increased intracellular-weighted sodium signal (assessed by 23Na-magnetic resonance imaging) in leg muscles.
CRIS-Team Scopus Importer:2020-08-28
Keywords: 23Na-MRI; Aberrant splicing; Becker muscular dystrophy; Dystrophin; Intracellular-weighted sodium signal; Next generation sequencing

RATES OF PROGRESSION DIFFER BETWEEN STRUCTURAL PHENOTYPES OF KNEE OSTEOARTHRITIS: A SECONDARY ANALYSIS FROM THE FNIH COHORT - Roemer, Frank; Collins, J.; Neogi, T.; Crema, M.; Guermazi, A. (ANNALS OF THE RHEUMATIC DISEASES, 2020)
CRIS-Team WoS Importer:2020-08-21

Reaching for better image quality and lower radiation dose in head and neck CT: advanced modeled and sinogram-affirmed iterative reconstruction in combination with tube voltage adaptation - Schmid, Andrea; Uder, Michael; Lell, Michael (Dentomaxillofacial Radiology, 2016)
The aim of this study was to evaluate image quality and radiation dose in low-dose head and neck CT comparing two different commercially available iterative reconstruction algorithms: sinogram-affirmed iterative reconstruction (SAFIRE) and advanced modeled iterative reconstruction (ADMIRE) with fixed and automated tube voltage adaptation (TVA).CT examinations of 103 patients were analysed. 58 patients were examined on a single-source CT at fixed tube voltage of 120 kV and reconstructed with filtered back projection (FBP) and SAFIRE (Strength Level 3). 45 patients were examined in a single-source mode on a dual-source CT with automated TVA and reconstructed with FBP and ADMIRE (Strength Levels 2 and 3). Image noise was calculated in seven anatomical volumes of interest. Subjective evaluation of the CT images was performed using a four-grade scale.Mean CT numbers of FBP and the corresponding iterative reconstruction did not differ significantly (p = 0.74-0.99). Image noise was lower with both iterative reconstruction techniques than with FBP (SAFIRE 3: -22.3%; ADMIRE 2: -14.9%; ADMIRE 3: -24.2%; all p < 0.05); hence, the signal-to-noise ratio and the contrast-to-noise values were higher. Subjective image quality revealed a more favourable result for the iterative reconstruction. ADMIRE 3 in combination with automated TVA showed 14.4% (p < 0.05) less image noise with a 7.5% lower radiation dose than SAFIRE 3 with fixed tube voltage.Higher image quality at lower radiation dose can be achieved using ADMIRE in combination with automated TVA.
EVALuna2:14596

Reactivation of HCMV during RT of the brain results in critical illness and early mortality - Frey, Benjamin; Goerig, Nicole; Becker, Ina; Donaubauer, Anna-Jasmina; Korn, Klaus; Überla, Klaus; Schmidt, Manuel; Dörfler, Arnd; Engelhorn, Tobias; Eyüpoglu, Ilker Yasin; Putz, Florian; Semrau, Sabine; et al. (RADIOTHERAPY AND ONCOLOGY, 2020)
CRIS-Team WoS Importer:2021-06-18

Real-Time, In Vivo Monitoring, and Quantitative Assessment of Intra-Arterial Vasospasm Therapy - Gölitz, Philipp; Kaschka, Iris; Lang, Stefan; Roessler, Karl; Knossalla, Frauke; Dörfler, Arnd (Neurocritical Care, 2016)
Our study aimed to evaluate whether the effect of an intra-arterial vasospasm therapy can be assessed quantitatively by in vivo blood flow analysis using the postprocessing algorithm parametric color coding (PCC).We evaluated 17 patients presenting with acute clinical deterioration due to vasospasm following subarachnoidal hemorrhage treated with intra-arterial nimodipine application. Pre- and post-interventional DSA series were post-processed by PCC. The relative time to maximum opacification (rTmax) was calculated in 14 arterially and venously located points of interest. From that data, the pre- and post-interventional cerebral circulation time (CirT) was calculated. Additionally, the arterial vessel diameters were measured. Pre- and post-interventional values were compared and tested for significance, respectively.Flow analysis revealed in all arterial vessel segments a non-statistically significant prolongation of rTmax after treatment. The mean CirT was 5.62 s (±1.19 s) pre-interventionally and 5.16 s (±0.81 s) post-interventionally, and the difference turned out as statistically significant (p = 0.039). A significantly increased diameter was measurable in all arterial segments post-interventionally.PCC is a fast applicable imaging technique that allows via real-time and in vivo blood flow analysis a quantitative assessment of the effect of intra-arterial vasospasm therapy. Our results seem to validate in vivo that an intra-arterial nimodipine application induces not only vasodilatation of the larger vessels, but also improves the microcirculatory flow, leading to a shortened cerebral CirT that reaches normal range post-interventionally. Procedural monitoring via PCC offers the option to compare quantitatively different therapy regimes, which allows optimization of existing approaches and implementation of individualized treatment strategies.
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Real world application of ocrelizumab in multiple sclerosis: Single-center experience of 128 patients - Prockl, Victoria; Nickel, Franziska; Utz, Kathrin S.; Fröhlich, Kilian; Engelhorn, Tobias; Hilz, Max-Josef; Lee, De-Hyung; Linker, Ralf; Huhn, Konstantin (Journal of the Neurological Sciences, 2020)
Background: Pivotal trials showed good clinical efficiency of the monoclonal antibody ocrelizumab while being well tolerated and manageable in multiple sclerosis (MS). However, data on adverse events in everyday practice are scarce. Hence, our study aims at investigating short-term tolerability of ocrelizumab in a “real-world” setting. Methods: In this retrospective cohort study, data of 128 (86 relapsing-remitting, 42 progressive) MS patients at initiation of ocrelizumab were analyzed at the MS center of the University of Erlangen, Germany. Additionally, follow-up data of 68 patients at 6-months retreatment were analyzed. Structured phone interviews were applied after ocrelizumab initiation to report undocumented side effects. Results: Patients predominantly switched from monoclonal antibodies (46%), orals (20%), injectables (10%), steroids or immunosuppressants (each 8%), with a mean interval of 9.0 months after the last application of the previous immunotherapy. Applying a combined premedication with steroids, antihistamines and antipyretics for >90% of patients, ocrelizumab treatment was well tolerated and mainly comprised mild (n = 59/128 at initiation, n = 5/68 at 6 months retreatment) and rarely moderate (n = 7/128 at initiation, n = 2/68 at 6 months) side effects. Predominantly mild infusion related reactions (IRR) were reported with a declining percentage over the follow-up applications. Infections occurred rarely. No severe side effects were observed. Secondary, treatment appeared efficient when looking at clinical surrogates of stable disease. Discussion: Our study delineates good short-term tolerability of ocrelizumab in a miscellaneous “real-world” MS cohort. Additional studies are warranted to confirm these beneficial findings and to reveal safety concerns in the longer-term follow-up.
CRIS-Team Scopus Importer:2020-06-26
Keywords: B-cell depletion; CD 20; Immunomodulatory treatment; Monoclonal antibody; Multiple sclerosis; Ocrelizumab; Side effects

Recent advances in research imaging of osteoarthritis with focus on MRI, ultrasound and hybrid imaging - Hayashi, D.; Roemer, Frank; Guermazi, A. (Clinical and Experimental Rheumatology, 2018)
For imaging of osteoarthritis (OA), MRI plays a major role in the research setting, with compositional MRI techniques becoming increasingly more important thanks to their capacity to assess 'premorphologic' biochemical compositional changes of articular and periarticular tissues. Although radiography remains the primary imaging modality in OA clinical trials, known limitations for visualisation of OA features significantly limits the utility of radiography both clinically and in the research arena. Compositional MRI techniques can potentially supplement routine clinical MRI sequences to identify cartilage degeneration at an earlier stage when radiographs may be normal. Ultrasound can be a useful adjunct to radiography and MRI particularly for evaluation of hand OA and for the evaluation of synovitis. Emerging hybrid imaging techniques including PET/MRI and PET/CT allow evaluation of the joint with simultaneous assessment of morphological changes and metabolic activities, showing a potential for these hybrid systems to play an increasing role in OA research.
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Recent technical developments and clinical research applications of sodium (23Na) MRI - Gast, Lena; Platt, Tanja; Nagel, Armin Michael; Gerhalter, Teresa (Progress in Nuclear Magnetic Resonance Spectroscopy, 2023)
Sodium is an essential ion that plays a central role in many physiological processes including the transmembrane electrochemical gradient and the maintenance of the body's homeostasis. Due to the crucial role of sodium in the human body, the sodium nucleus is a promising candidate for non-invasively assessing (patho-)physiological changes. Almost 10 years ago, Madelin et al. provided a comprehensive review of methods and applications of sodium (23Na) MRI (Madelin et al., 2014) [1]. More recent review articles have focused mainly on specific applications of 23Na MRI. For example, several articles covered 23Na MRI applications for diseases such as osteoarthritis (Zbyn et al., 2016, Zaric et al., 2020) [2,3], multiple sclerosis (Petracca et al., 2016, Huhn et al., 2019) [4,5] and brain tumors (Schepkin, 2016) [6], or for imaging certain organs such as the kidneys (Zollner et al., 2016) [7], the brain (Shah et al., 2016, Thulborn et al., 2018) [8,9], and the heart (Bottomley, 2016) [10]. Other articles have reviewed technical developments such as radiofrequency (RF) coils for 23Na MRI (Wiggins et al., 2016, Bangerter et al., 2016) [11,12], pulse sequences (Konstandin et al., 2014) [13], image reconstruction methods (Chen et al., 2021) [14], and interleaved/simultaneous imaging techniques (Lopez Kolkovsky et al., 2022) [15]. In addition, 23Na MRI topics have been covered in review articles with broader topics such as multinuclear MRI or ultra-high-field MRI (Niesporek et al., 2019, Hu et al., 2019, Ladd et al., 2018) [16–18]. During the past decade, various research groups have continued working on technical improvements to sodium MRI and have investigated its potential to serve as a diagnostic and prognostic tool. Clinical research applications of 23Na MRI have covered a broad spectrum of diseases, mainly focusing on the brain, cartilage, and skeletal muscle (see Fig. 1). In this article, we aim to provide a comprehensive summary of methodological and hardware developments, as well as a review of various clinical research applications of sodium (23Na) MRI in the last decade (i.e., published from the beginning of 2013 to the end of 2022).
CRIS-Team Scopus Importer:2023-06-09
Keywords: Multinuclear MRI; Sodium (; Sodium ions (Na; Tissue sodium concentration (TSC); X-nuclei imaging

Recommendations on exercise methods for bone strengthening - von Stengel, Simon; Kohl, Matthias; Jakob, Franz; Kerschan-Schindl, Katharina; Lange, Uwe; Peters, Stefan; Thomasius, Friederike; Uder, Michael; Shojaa, Mahdieh; Kemmler, Wolfgang (Osteologie, 2023)
The optimum composition of strain parameters (or loading parameters) is crucial in designing exercise protocols with positive effects on bone strength and associated parameters. Although strain parameters related to bone adaption differ slightly from the common terminology usually applied in sport sciences, their categorization is very similar. Introducing strain parameters, (1) strain magnitude is characterized by the extent of the deformation of the bone caused by loading, while (2) strain rate represents the alteration in strain magnitude per second during the acceleration or deceleration of loading. (3) Training frequency and (4) cycle number indicate the amount of training sessions (usually per week) and the number of loading cycles/repetitions per set/session, while (5) strain duration is characterized by the length of a single loading cycle. (6) Strain frequency represents the number of loading cycles per sec (Hz) and finally (6) strain density characterizes the relationship between loading and rest periods with respect to single loading cycles, sets of cycles, training sessions or training periods (mesocycles). In summary, exercise programs applied with high strain magnitude and rate and a short cycle duration in a dynamic mode at least twice/week showed the highest osteoanabolic potency. The number of repetitions plays a minor role, at least when high exercise intensity (high strain magnitude-/rate) was applied. However, there is some evidence that stimuli around or (slightly) below bone mechanical threshold can be raised to a supra-threshold level by increasing the number of repetitions. The same might also be the case for strain frequency in the spectrum of voluntary movements (<5 Hz). The relevance of strain density is closely related to the "desensitization phenomena" of bone after repeated intense loading. Applying regular resensitization periods without relevant mechanical loading between phases of intense bone specific exercise enables other important training aims to be addressed with high emphasis during the corresponding periods.
CRIS-Team WoS Importer:2023-05-12

Reconstruction of the vascular compromised lower extremity - report of the consensus workshop at the 35. Meeting of the DAM (Deutschsprachige Gemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße) 2013 in Deidesheim - Daigeler, A.; Kneser, U.; Fansa, H.; Riester, T.; Uder, Michael; Horch, Raymund E. (Handchirurgie, Mikrochirurgie, Plastische Chirurgie, 2014)
As microsurgical reconstruction is now being increasingly performed on patients with critical peripheral perfusion and/or arterial occlusive disease in numerous centres, there is a need for standardisation of interdisciplinary diagnostic approach and treatment regimens in such critically ill patients. In a consensus workshop on reconstruction of the vascular compromised lower extremity during the 35th Annual Meeting of the German working group microsurgery of the peripheral nerves and vessels (DAM) in 2013 in Deidesheim, DAM members together with vascular surgeons and interventional radiologists attempted to establish interdisciplinarily routine pathways for diagnosis and therapy and to consolidate key recommendations for treatment.By reviewing the literature and considering the results of the expert meetings, options and limits of therapy were illustrated and recommendations for successful cooperative treatment formulated.By means of interdisciplinary cooperation, limbs can be salvaged and the quality of live as well as survival of patients with severe peripheral vascular disease improved. Different techniques including angioplasty, bypass surgery and microsurgical free flaps can be applied and individualised concepts allow extremity salvage even in patients with severely compromised limbs. Revascularisation provides the possibility of free flap transfer while the risk for the patients is moderate.The poor general condition of the patient requires a sufficient interdisciplinary preoperative planning. By means of interdisciplinary cooperation, the limbs can be salvaged. This not only improves the quality of life but also increases the survival time of patients with occlusive vascular disease. Different concepts for this group of patients have been developed. Surgical treatment with a distal bypass or recanalisation and free flap not only allow for the coverage of large defects, but also represent a haemodynamic advantage by increased blood flow in the bypass. This is attributed to the additional vascular bed that is transplanted with the free flap. Limb salvage means relevant improvement, however, the initially less demanding procedure of amputation must always be considered.
EVALuna2:14357

Recurrence of glioblastoma is associated with elevated microvascular transit time heterogeneity and increased hypoxia - Stadlbauer, Andreas; Mouridsen, Kim; Dörfler, Arnd; Hansen, Mikkel Bo; Oberndorfer, Stefan; Zimmermann, Max; Buchfelder, Michael; Heinz, Gertraud; Roessler, Karl (Journal of Cerebral Blood Flow and Metabolism, 2018)
Dynamic susceptibility contrast (DSC) perfusion MRI provide information about differences in macro- and microvasculature when executed with gradient-echo (GE; sensitive to macrovasculature) and spin-echo (SE; sensitive to microvasculature) contrast. This study investigated whether there are differences between macro- and microvascular transit time heterogeneity (MVTH and µVTH) and tissue oxygen tension (PO2mit) in newly-diagnosed and recurrent glioblastoma. Fifty-seven patients with glioblastoma (25 newly-diagnosed/32 recurrent) were examined with GE- and SE-DSC perfusion sequences, and a quantitative blood-oxygen-level-dependent (qBOLD) approach. Maps of MVTH, µVTH and coefficient of variation (MCOV and µCOV) were calculated from GE- and SE-DSC data, respectively, using an extended flow-diffusion equation. PO2mit maps were calculated from qBOLD data. Newly-diagnosed and recurrent glioblastoma showed significantly lower ( P ≤ 0.001) µCOV values compared to both normal brain and macrovasculature (MCOV) of the lesions. Recurrent glioblastoma had significantly higher µVTH ( P = 0.014) and µCOV ( P = 0.039) as well as significantly lower PO2mit values ( P = 0.008) compared to newly-diagnosed glioblastoma. The macrovasculature, however, showed no significant differences. Our findings provide evidence of microvascular adaption in the disorganized tumor vasculature for retaining the metabolic demands in stress response of therapeutically-uncontrolled glioblastomas. Thus, µVTH and PO2mit mapping gives insight into the tumor microenvironment (vascular and hypoxic niches) responsible for therapy resistance.
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Recurrent shock and pulmonary edema due to acetazolamide medication after cataract surgery - Zimmermann, S.; Achenbach, Susanne; Wolf, M.; Janka, Rolf Matthias; Marwan, M.; Mahler, V. (Heart & Lung, 2014)
We report a patient with recurrent shock and transient non-cardiogenic pulmonary edema within a period of two months - every time occurring after cataract surgery and a single oral dose of standard post-operative medication with acetazolamide.Records of the intensive care unit, review of the literature.This case demonstrates a rare but severe side effect of acetazolamide. We also present a review of the literature to raise the awareness of health care providers for this special form of non-cardiogenic pulmonary edema.
EVALuna2:11868

Reduced tissue sodium content is related to improvement of vascular function in patients with chronic heart failure treated with the SGLT2 inhibitor empagliflozin - Kolwelter, Julie; Kannenkeril, Dennis; Linz, Peter; Jung, Susanne; Nagel, Armin Michael; Bosch, Agnes; Ott, Christian; Bramlage, P.; Uder, Michael; Achenbach, Stephan; Schmieder, Roland (EUROPEAN HEART JOURNAL, 2021)
CRIS-Team WoS Importer:2021-12-10

Reduction of cerebral infarct size by dronedarone - Engelhorn, Tobias; Schwarz, Marc A.; Heusch, Gerd; Dörfler, Arnd; Schulz, Rainer (Cardiovascular Drugs and Therapy, 2011)
In the ATHENA trial, dronedarone reduced the incidence of stroke in patients with atrial fibrillation. Since smaller cerebral infarcts are sometimes asymptomatic, the reduced incidence of stroke might reflect reduction of infarct size (IS) by dronedarone. However, no data on this effect of dronedarone are available.In 60 rats, the middle cerebral artery was occluded (MCAO) for 1 h followed by reperfusion. IS was assessed at day 7. Animals were examined using a neurological 5 points score. Twelve animals served as controls (group A), 12 animals received 30 mg/kg (group B) and 100 mg/kg (group C) dronedarone daily starting 3 days before MCAO; 12 animals received 30 mg/kg (group D) starting 2 h after MCAO. In all groups treatment was maintained until day 7. In 12 additional animals (6 controls, 6 pretreated animals) fractional anisotropy (FA) was assessed using magnetic resonance imaging (MRI).IS in group A was 151 ± 45 mm(3) versus 94 ± 42 mm(3) in group B, 79 ± 29 mm(3) in group C, and 127 ± 51 mm(3) in group D, respectively (B,C,D P < 0.05 vs. A). Neuroscores and weight loss (expressed as percent of initial weight) were less in treatment groups: 1.8 ± 0.6 and 91% in group B, 1.4 ± 0.5 and 93% in group C, and 2.1 ± 0.6 and 89% in group D compared to 2.4 ± 0.5 and 83% in controls (B,C,D P < 0.05 vs. A). FA in the ischemic penumbra was significantly higher in treated than in control animals (0.44 ± 0.2 vs. 0.35 ± 0.17; P < 0.05).Dronedarone administered before and after MCAO reduces IS and improves FA and neurological outcome in transient cerebral ischemia.
EVALuna2:22954

Reduction of the cardiac pulsation artifact and improvement of lesion conspicuity in flow-compensated diffusion images in the liver-A quantitative evaluation of postprocessing algorithms - Führes, Tobit; Saake, Marc; Lorenz, Jennifer; Seuß, Hannes; Stemmer, Alto; Benkert, Thomas; Uder, Michael; Laun, Frederik Bernd (Magnetic Resonance in Medicine, 2022)
Purpose To enhance image quality of flow-compensated diffusion-weighted liver MRI data by increasing the lesion conspicuity and reducing the cardiac pulsation artifact using postprocessing algorithms. Methods Diffusion-weighted image data of 40 patients with liver lesions had been acquired at 1.5 T. These data were postprocessed with 5 different algorithms (weighted averaging, p-mean, percentile, outlier exclusion, and exception set). Four image properties of the postprocessed data were evaluated for optimizing the algorithm parameters. These properties were the lesion to tissue contrast-to-noise ratio (CNR), the reduction of the cardiac pulsation artifact, the data consistency, and the vessel darkness. They were combined into a total quality score ( set to 1 for the trace-weighted reference image), which was used to rate the image quality objectively. Results The weighted averaging algorithm performed best according to the total quality score (). The further ranking was outlier exclusion algorithm (), p-mean algorithm (), percentile algorithm (), and exception set algorithm (). All optimized algorithms except for the exception set algorithm corrected the pulsation artifact and increased the lesion CNR. Changes in were significant for all optimized algorithms except for the percentile algorithm. Liver ADC was significantly reduced (except for the exception set algorithm), particularly in the left lobe. Conclusion Postprocessing algorithms should be used for flow-compensated liver DWI. The proposed weighted averaging algorithm seems to be suited best to increase the image quality of artifact-corrupted flow-compensated diffusion-weighted liver data.
CRIS-Team WoS Importer:2022-09-23

Reduction of Tissue Na+ Accumulation After Renal Transplantation - Dahlmann, Anke; Linz, Peter; Zucker, Isabelle; Haag, Viktor; Jantsch, Jonathan; Dienemann, Thomas; Nagel, Armin Michael; Neubert, Patrick; Rosenhauer, Daniela; Rauh, Manfred; Horn, Stephan; Müller, Dominik N.; et al. (Kidney International Reports, 2021)
Introduction: Chronic kidney disease (CKD) engenders salt-sensitive hypertension. Whether or not tissue Nathorn accumulation is increased in CKD patients remains uncertain. How tissue Nathorn is affected after renal transplantation has not been assessed.
CRIS-Team WoS Importer:2021-10-01

Reduction of tissue sodium content by SGLT-2-inhibition with dapagliflozin - Karg, M. V.; Ott, Christian; Linz, Peter; Jumar, A.; Kannenkeril, D.; Titze, J.; Hammon, Matthias; Uder, Michael; Schmieder, Roland (2017)
EVALuna2:36268

Reduction of X-ray-induced DNA damage in normal human cells treated with the PrC-210 radioprotector - Brand, Michael; Sommer, Matthias; Jermusek, Frank; Fahl, William E.; Uder, Michael (Biology Open, 2018)
The aim of our study was to determine the protective efficacy of the PrC-210 aminothiol radioprotector against X-ray-induced DNA damage in normal human cells and to establish dose- and time-effect models for future PrC-210 use in humans. The PrC-210 structure has a branched structure which enables scavenging of reactive oxygen species (ROS) away from DNA. Normal human blood lymphocytes, fibroblasts and naked genomic DNA were exposed to PrC-210 seconds to hours prior to irradiation. Biological (γ-H2AX foci), chemical (8-oxo-deoxyguanosine) and physical (genomic DNA electrophoretic migration) DNA damage endpoints were scored to determine the ability of PrC-210 to suppress radiation-induced DNA damage. X-ray-induced γ-H2AX foci in blood lymphocytes were reduced by 80% after irradiation with 10, 50 and 100 mGy, and DNA double-strand breaks in fibroblasts were reduced by 60% after irradiation with 20 Gy. Additionally, we observed a reduction of 8-oxo-deoxyguanosine (an ROS-mediated, DNA damage marker) in human genomic DNA to background in a PrC-210 dose-dependent manner. PrC-210 also eliminated radiation-induced cell death in colony formation assays after irradiation with 1 Gy. The protective efficacy of PrC-210 in each of these assay systems supports its development as a radioprotector for humans in multiple radiation exposure settings.
EVALuna2:36109

Refined Functional Magnetic Resonance Imaging and Magnetoencephalography Mapping Reveals Reorganization in Language-Relevant Areas of Lesioned Brains - Zimmermann, Max; Rössler, Karl; Kaltenhäuser, Martin; Grummich, Peter; Yang, Bing; Buchfelder, Michael; Dörfler, Arnd; Kölble, Konrad; Stadlbauer, Andreas (World Neurosurgery, 2019)
BACKGROUND: Neurosurgical decisions regarding interventions close to brain areas with language-related functions remain highly challenging because of the risk of postoperative dysfunction. To minimize these risks, improvements in the preoperative mapping of language-related regions are required, especially as space-occupying lesions often lead to altered cortical topography and language area reorganization. METHODS: The degree of deviation and language area reorganization were investigated in 26 functional magnetic resonance imaging- and magnetoencephalography-dissociable cortical sub-areas displaying language-related activations in each of 18 patients with brain lesions and 3 healthy volunteers (during visual language tasks). RESULTS: Both modalities showed good congruency of the language areas. The mean spatial distance of the centroids and maxima was 9.06 mm and 10.58 mm, respectively, allowing us to define more specific anatomical positions. Postoperatively, language abilities increased in 11% (2 of 18) of the patients, remained unchanged in 83% (15 of 18) of the patients, and decreased in 6% (1 of 18) of the patients, respectively. Signs of language function reorganization detected on both functional magnetic resonance imaging and magnetoencephalography were present in 29% (5 of 17) of the patients. Attenuation of neurovascular coupling was found postoperatively in 17% (3 of 18) of the patients. Monohemispheric language processing cannot be assumed always in patients with brain lesions. CONCLUSIONS: The more detailed subdivision of language-relevant brain areas shown in this study can help to achieve more radical tumor resection without postoperative language deficits.
EVALuna2:212793

Refined Functional Magnetic Resonance Imaging and Magnetoencephalography Mapping Reveals Reorganization in Language-Relevant Areas of Lesioned Brains - Zimmermann, Max; Rössler, Karl; Kaltenhäuser, Martin; Grummich, Peter; Yang, Bing; Buchfelder, Michael; Dörfler, Arnd; Kölble, Konrad; Stadlbauer, Andreas (World Neurosurgery, 2020)
Background: Neurosurgical decisions regarding interventions close to brain areas with language-related functions remain highly challenging because of the risk of postoperative dysfunction. To minimize these risks, improvements in the preoperative mapping of language-related regions are required, especially as space-occupying lesions often lead to altered cortical topography and language area reorganization. Methods: The degree of deviation and language area reorganization were investigated in 26 functional magnetic resonance imaging- and magnetoencephalography-dissociable cortical sub-areas displaying language-related activations in each of 18 patients with brain lesions and 3 healthy volunteers (during visual language tasks). Results: Both modalities showed good congruency of the language areas. The mean spatial distance of the centroids and maxima was 9.06 mm and 10.58 mm, respectively, allowing us to define more specific anatomical positions. Postoperatively, language abilities increased in 11% (2 of 18) of the patients, remained unchanged in 83% (15 of 18) of the patients, and decreased in 6% (1 of 18) of the patients, respectively. Signs of language function reorganization detected on both functional magnetic resonance imaging and magnetoencephalography were present in 29% (5 of 17) of the patients. Attenuation of neurovascular coupling was found postoperatively in 17% (3 of 18) of the patients. Monohemispheric language processing cannot be assumed always in patients with brain lesions. Conclusions: The more detailed subdivision of language-relevant brain areas shown in this study can help to achieve more radical tumor resection without postoperative language deficits.
CRIS-Team Scopus Importer:2020-02-14
Keywords: Brain tumor; Broca; fMRI; Language; MEG; Reorganization; Wernicke

Regions at Risk in the Knee Joint of Young Professional Soccer Players: Longitudinal Evaluation of Early Cartilage Degeneration by Quantitative T2 Mapping in 3 T MRI - Schenker, Hannah; Simon, David; Waldenmeier, Leonie; Evers, Christoph; Janka, Rolf Matthias; Welsch, Goetz H.; Pachowsky, Milena (Cartilage, 2020)
Purpose. The study aims to detect regions at risk for (pre-)osteoarthritis in the tibiofemoral joint of young professional soccer players by evaluating cartilage composition by T2 mapping in a 3 T magnetic resonance imaging setting. Methods. In this longitudinal study, 20 professional adolescent soccer players were included. Tibiofemoral cartilage was assessed by quantitative T2 mapping and T2 values were evaluated by regions of interest analysis. Statistical evaluation, using Wilcoxon signed-rank tests, was performed to compare global T2 values and subregional T2 values between a baseline and a follow-up investigation 4.3 years later. Based on the average of playing time (15 years) we divided the cohort in 2 groups and differences were evaluated. Results. When comparing baseline and follow-up, our findings showed statistically significant increases of the global medial tibial and femoral T2 values. The most noticeable results of the subregional T2 analysis were statistically significant increases in the medial posterior zones (deep femoral 36.1 vs. 39.5, P = 0.001; superficial femoral 57.0 vs. 62.4, P = 0.034; deep tibial 28.3 vs. 34.1, P = 0.009; superficial tibial 43.2 vs. 55.3, P = 0.002). Conclusion. The elevation of T2 values in the medial, especially medial posterior, compartment of the knee joint indicates that these regions are at risk for early cartilage degeneration already at the time of adolescence. The findings can help individualize and optimize training concepts and to be aware of the chronic stress on these vulnerable areas. Prevention programs should be established in young players to avoid further cartilage damage.
CRIS-Team Scopus Importer:2020-06-02
Keywords: adolescent; cartilage; MRI; sports; T2 mapping

Registration of functional and morphological volume data sets - Hornegger, Joachim; Römer, Wolfgang; Bautz, Werner; Kuwert, Torsten (35th Jahrestagung der Gesellschaft fur Informatik e.V. (GI): Informatik LIVE!, INFORMATIK 2005 35th Annual Conference of the German Informatics Society (GI): Informatics LIVE!, INFORMATIK 2005, 2005)

Rehabilitation after a complete avulsion of the proximal rectus femoris muscle: Considerations from a case report - Baumgart, Christian; Grim, Casper; Heiß, Rafael; Ehrenstein, Philipp; Freiwald, Jürgen; Hoppe, Matthias Wilhelm (International Journal of Environmental Research and Public Health, 2021)
Background: A complete avulsion of the proximal rectus femoris muscle is a rare but se-verity injury. There is a lack of substantial information for its operative treatment and rehabilitation; in particular there is a lack of biomechanical data to evaluate long-term outcomes. Case presenta-tion: The case report presents the injury mechanism and surgical treatment of a complete avulsion of the proximal rectus femoris muscle in a 41-year-old recreational endurance athlete. Moreover, within a one-year follow-up period, different biomechanical tests were performed to get more functional insights into changes in neuromuscular control, structural muscle characteristics, and endurance performance. Within the first month post-surgery, an almost total neuromuscular inhibition of the rectus femoris muscle was present. A stepwise reduction in inter-limb compensations was ob-servable (e.g., in crank torque during cycling) during the rehabilitation. Muscular intra-limb compensations were shown at six months post-surgery and even one year after surgery, which were also represented in the long-term adaption of the muscle characteristics and leg volumes. A changed motor control strategy was shown by asymmetric muscle activation patterns during ergometer cy-cling, while the power output was almost symmetric. During rehabilitation, there might be a benefit to normalizing neuromuscular muscle activation in ergometer cycling using higher loads. Conclu-sions: While the endurance performance recovered after six months, asymmetries in neuromuscular control and structural muscle characteristics indicate the long-term presence of inter-and intra-limb compensation strategies.
CRIS-Team Scopus Importer:2021-08-27
Keywords: Electromyography; Isokinetic; Muscle injury; Quadriceps; Rehabilitation; Strength; Surgery; Tendon rupture

Reirradiation of recurent glioblastomas: High prognostic significance of contrast-enhancing tumor volume - Mansoorian, Sina; Coras, Roland; Weissmann, Thomas; Lettmaier, Sebastian; Semrau, Sabine; Frey, Benjamin; Bert, Christoph; Schmidt, M.; Fietkau, Rainer; Putz, Florian (STRAHLENTHERAPIE UND ONKOLOGIE, 2021)
CRIS-Team WoS Importer:2021-07-16

Relation of Knee Extensor Power to Worsening Cartilage Damage in the Knee: The MOST Study - Stefanik, Joshua; Felson, David; Lewis, Cara; Rabasa, Gabriela; Guermazi, Ali; Roemer, Frank; Nevitt, Michael; Lewis, Cora; Segal, Neil (ARTHRITIS & RHEUMATOLOGY, 2021)
CRIS-Team WoS Importer:2022-03-11

Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the Multicenter Osteoarthritis Study - Hart, H. F.; Crossley, K. M.; Felson, D.; Jarraya, M.; Guermazi, A.; Roemer, Frank; Lewis, C. E.; Torner, J.; Nevitt, M.; Stefanik, J. J. (Osteoarthritis and Cartilage, 2018)
OBJECTIVE: To determine the relationship of meniscal damage to magnetic resonance imaging (MRI) features of compartment-specific patellofemoral joint (PFJ) osteoarthritis (OA) at baseline and 2 years later. METHOD: Individuals from a prospective cohort of individuals aged 50-79 with or at risk of knee OA were included. At the 60-month and 84-month study visit, Whole-Organ MRI Score (WORMS) was used to assess meniscal tears and extrusions as well as cartilage damage and bone marrow lesions (BMLs) in the medial and lateral patella and trochlea. Worsening of structural features was defined as any increase in WORMS score from 60 to 84 months. Logistic regression was used to determine the cross-sectional and longitudinal relation of meniscus damage to features of compartment-specific PFJ OA. RESULTS: Relative to knees without lateral meniscal pathology at baseline, those with grades 3-4 lateral meniscal tear and extrusion had greater risk of worsening of cartilage damage in the lateral PFJ 2 years later (Risk ratio: 1.7 [95% CI: 1.1-2.7) and (1.7 [1.2-2.5]), respectively. Relative to those without medial meniscal pathology at baseline, those with grades 1-2 (0.6 [0.4-0.9]) and 3-4 (0.7 [0.5-1.0]) medial meniscal tears had lower risk of worsening of BMLs in the medial PFJ 2 years later. CONCLUSION: Meniscal tear and extrusion are associated with increased risk of medial and lateral PFJ OA and more severe meniscal pathology is associated with worsening of PFJ OA 2 years later. Lateral meniscal pathology appears to be more detrimental to the lateral PFJ.
EVALuna2:36245

Relation of MRI-Detected Features of Patellofemoral Osteoarthritis to Pain, Performance-Based Function, and Daily Walking: The Multicenter Osteoarthritis Study - Maxwell, J. L.; Neogi, T.; Crossley, Kay M.; Macri, Erin M.; White, Dan; Guermazi, A.; Roemer, Frank; Nevitt, M. C.; Lewis, C. E.; Torner, J. C.; Stefanik, J. J. (ACR Open Rheumatology, 2021)
Objective The study objective was to determine the relationship of magnetic resonance imaging (MRI)-detected features of patellofemoral joint osteoarthritis to pain and functional outcomes. Methods We sampled 1,099 participants from the 60-month visit of the Multicenter Osteoarthritis Study (mean +/- SD age: 66.8 +/- 7.5 years; body mass index: 29.6 +/- 4.8; 65% female). We determined the prevalence of MRI-detected features of patellofemoral joint osteoarthritis (eg, cartilage damage, bone marrow lesions, and osteophytes) and assessed the relationship between these features and knee pain severity, knee pain on stairs, chair stand time, and walking less than 6,000 steps per day. We evaluated the relationship of MRI features to each outcome using logistic and linear regression, adjusting for potential covariates. Results Participants with cartilage damage in 3-4 subregions had the highest mean pain severity (22.0/100; 95% confidence interval [CI]: 17.6-26.4 mm). They also showed higher odds of having at least mild pain on stairs (odds ratio [OR]: 3.3; 95% CI: 1.7-6.5) and of walking less than 6,000 steps per day (OR: 2.3; 95% CI: 1.1-4.4) compared with those without cartilage damage. Participants with bone marrow lesions in 3-4 subregions had higher odds of at least mild pain on stairs than those without (OR: 3.3; 95% CI: 2.2-5.2). Participants with osteophytes in 3-4 subregions also had higher odds of walking less than 6,000 steps/day (OR 2.1, 95% CI: 1.3-3.5, respectively). Conclusion MRI-detected features of osteoarthritis of the patellofemoral joint are related to pain and functional performance. This knowledge highlights the need to develop treatments for those with patellofemoral joint osteoarthritis to improve pain and maximize function.
CRIS-Team WoS Importer:2021-12-03

Relation of MRI-detected Structural Damage in the Patellofemoral Joint to Pain and Performance Based Function: The MOST Study - Maxwell, Jessica; Neogi, Tuhina; Crossley, Kay; Macri, Erin; White, Daniel; Guermazi, Ali; Roemer, Frank; Nevitt, Michael; Lewis, Beth; Torner, James; Stefanik, Joshua (ARTHRITIS & RHEUMATOLOGY, 2019)
CRIS-Team WoS Importer:2020-02-07

Relation of Step Length to Magnetic Resonance Imaging-Detected Structural Damage in the Patellofemoral Joint: The Multicenter Osteoarthritis Study - Stefanik, Joshua J.; Gross, K. Douglas; Guermazi, Ali; Felson, David T.; Roemer, Frank; Niu, Jingbo; Lynch, John A.; Segal, Neil A.; Lewis, Cora E.; Lewis, Cara L. (Arthritis & Rheumatism-Arthritis Care & Research, 2016)
To investigate the relationship of step length to the sex-specific prevalence and worsening of magnetic resonance imaging (MRI)-detected structural damage in the patellofemoral (PF) joint among a cohort of older women and men with or at risk of knee osteoarthritis (OA).The Multicenter Osteoarthritis Study is a cohort study of persons ages 50-79 years with or at risk of knee OA. Step length was assessed using the GAITRite walkway (CIR Systems) at the 60-month visit, and cartilage damage and bone marrow lesions (BMLs) were graded on MRI at the 60- and 84-month visits. Step length was divided into sex-specific quintiles, and the relationship of step length to the prevalence and worsening of cartilage damage and BMLs in the PF joint was examined using logistic regression, adjusting for age, body mass index (BMI), leg length, and tibiofemoral joint structural damage.In 1,053 knees, 4,094 and 4,083 PF joint subregions were studied for the cartilage and BML analyses, respectively. Mean ± SD age was 65.6 ± 8.1 years and mean ± SD BMI was 29.1 ± 4.7 kg/m(2) ; 62% of participants were female. In women, compared to those with the shortest step length, those with the longest step length had 0.62 (95% confidence interval [95% CI] 0.43-0.88) and 0.59 (95% CI 0.40-0.87) times the odds of cartilage damage and BMLs, respectively. There was no cross-sectional association in men, and no longitudinal association in either sex.Women with PF joint structural damage may adapt their gait by shortening their step length, but this may not be sufficient to reduce the risk of worsening damage over time.
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RELATION OF STEP RATE TO WORSENING OF PATELLOFEMORAL AND TIBIOFEMORAL JOINT CARTILAGE DAMAGE IN WOMEN AND MEN - THE MOST STUDY - Hart, H. F.; Gross, K. D.; Crossley, K. M.; Barton, C. J.; Felson, D.; Guermazi, A.; Roemer, Frank; Lewis, B.; Segal, N.; Nevitt, M.; Stefanik, J. J. (2018)
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Relationship between low tube voltage (70 kV) and the iodine delivery rate (IDR) in CT angiography: An experimental in-vivo study - Lell, Michael M.; Fleischmann, Ulrike; Pietsch, Hubertus; Korporaal, Johannes G.; Haberland, Ulrike; Mahnken, Andreas H.; Flohr, Thomas G.; Uder, Michael; Jost, Gregor (PLoS ONE, 2017)
Very short acquisition times and the use of low-kV protocols in CTA demand modifications in the contrast media (CM) injection regimen. The aim of this study was to optimize the use of CM delivery parameters in thoraco-abdominal CTA in a porcine model.Six pigs (55-68 kg) were examined with a dynamic CTA protocol (454 mm scan length, 2.5 s temporal resolution, 70 s total acquisition time). Four CM injection protocols were applied in a randomized order. 120 kV CTA protocol: (A) 300 mg iodine/kg bodyweight (bw), IDR = 1.5 g/s (flow = 5 mL/s), injection time (ti) 12 s (60 kg bw). 70 kV CTA protocols: 150 mg iodine/kg bw: (B) IDR = 0.75 g/s (flow = 2.5 mL/s), ti = 12 s (60 kg bw); (C) IDR = 1.5 g/s (flow = 5 mL/s), ti = 12 s (60 kg bw); (D) IDR = 3.0 g/s (flow = 10 mL/s), ti = 3 s (60 kg bw). The complete CM bolus shape was monitored by creating time attenuation curves (TAC) in different vascular territories. Based on the TAC, the time to peak (TTP) and the peak enhancement were determined. The diagnostic window (relative enhancement > 300 HU), was calculated and compared to visual inspection of the corresponding CTA data sets.The average relative arterial peak enhancements after baseline correction were 358.6 HU (A), 356.6 HU (B), 464.0 HU (C), and 477.6 HU (D). The TTP decreased with increasing IDR and decreasing ti, protocols A and B did not differ significantly (systemic arteries, p = 0.843; pulmonary arteries, p = 0.183). The delay time for bolus tracking (trigger level 100 HU; target enhancement 300 HU) for single-phase CTA was comparable for protocol A and B (3.9, 4.3 s) and C and D (2.4, 2.0 s). The scan window time frame was comparable for the different protocols by visual inspection of the different CTA data sets and by analyzing the TAC.All protocols provided sufficient arterial enhancement. The use of a 70 kV CTA protocol is recommended because of a 50% reduction of total CM volume and a 50% reduced flow rate while maintaining the bolus profile. In contrast to pulmonary arterial enhancement, the systemic arterial enhancement improved only slightly increasing the IDR from 1.5 g/s to 3 g/s because of bolus dispersion of the very short bolus (3s) in the lungs.
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Relationship of Trochlear Morphology and Patellofemoral Joint Alignment to Superolateral Hoffa Fat Pad Edema on MR Images in Individuals with or at Risk for Osteoarthritis of the Knee: The MOST Study - Widjajahakim, Rafael; Roux, Michael; Jarraya, Mohamed; Roemer, Frank; Neogi, Tuhina; Lynch, John A.; Lewis, Cora E.; Torner, James C.; Felson, David T.; Guermazi, Ali; Stefanik, Joshua J. (Radiology, 2017)
Purpose To determine the relationship of patellofemoral joint alignment and trochlear morphology to superolateral Hoffa fat pad (SHFP) edema on magnetic resonance (MR) images in older adults with or at risk for osteoarthritis of the knee. Materials and Methods Institutional review board approval and written informed consent were obtained from all subjects. The Multicenter Osteoarthritis Study is a prospective cohort study of older adults with or at risk for osteoarthritis of the knee. Subjects were recruited from Birmingham, Alabama, and Iowa City, Iowa. In this cross-sectional study, patellofemoral joint alignment (bisect offset, patellar tilt angle, and Insall-Salvati ratio), trochlear morphology (sulcus angle, lateral and medial trochlear inclination, and trochlear angle) and SHFP edema were assessed on MR images of the knee. Measures of alignment and morphology were divided into quartiles, and SHFP was determined to be present or absent. Separate logistic regression models were used to determine the relationship of each measure of alignment and morphology to the presence of SHFP edema, with adjustments for age, sex, and body mass index. Results SHFP edema was present in 152 (13.4%) of the 1134 knees that were included. When compared with knees with measurements in the lowest quartile, knees with measurements in the highest quartile for trochlear angle, bisect offset, and Insall-Salvati ratios were 1.6 (95% confidence interval [CI]: 1.0, 2.6), 2.3 (95% CI: 1.3, 4.0), and 8.9 (95% CI: 4.7, 16.9) times more likely to show SHFP edema, respectively. No relationship was found between other measures and SHFP edema. Conclusion A more anterior trochlear facet, a more laterally displaced patella, and knees with patella alta were significantly associated with SHFP edema on MR images in subjects with or at risk for osteoarthritis of the knee. © RSNA, 2017.
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Relaxation-weighted Na-23 magnetic resonance imaging maps regional patterns of abnormal sodium concentrations in amyotrophic lateral sclerosis - Mueller, Hans-Peter; Nagel, Armin Michael; Keidel, Franziska; Wunderlich, Arthur; Hubers, Annemarie; Gast, Lena; Ludolph, Albert C.; Beer, Meinrad; Kassubek, Jan (Therapeutic Advances in Chronic Disease, 2022)
Objectives: Multiparametric magnetic resonance imaging (MRI) is established as a technical instrument for the characterisation of patients with amyotrophic lateral sclerosis (ALS). The contribution of relaxation-weighted sodium ((NaR)-Na-23) MRI remains to be defined. The aim of this study is to apply (NaR)-Na-23 MRI to investigate brain sodium homeostasis and map potential alterations in patients with ALS as compared with healthy controls.
CRIS-Team WoS Importer:2022-07-29

Reliability and agreement of sodium (23Na) MRI in calf muscle and skin of healthy subjects from the US - Dyke, Jonathan P.; Meyring-Wosten, Anna; Zhao, Yize; Linz, Peter; Thijssen, Stephan; Kotanko, Peter (Clinical Imaging, 2018)
PURPOSE: To quantify the reliability and agreement of sodium (23Na) MRI in calf muscle and skin of healthy subjects and to measure the smallest real difference (SRD) in each. SUBJECTS AND METHODS: Thirty healthy subjects underwent 23Na MRI studies of the calf. A scan-rescan protocol was performed the same day and 1 week later. Relative sodium concentration was measured in the calf muscle and skin and compared between studies. RESULTS: A high degree of reliability was confirmed between the scan and rescan tests using linear regression analysis. The Bland-Altman plots indicated high agreement between runs in all regions. The SRD was measured between scans taken the same day and one week later. Correlations were also reported with age, gender and race. CONCLUSIONS: Reliability and agreement of 23Na MRI in the calf muscle and skin show promise for accurately assessing serial changes in patients.
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Reliability of MRI assessment of acute musculotendinous groin injuries in athletes - Serner, Andreas; Roemer, Frank; Holmich, Per; Thorborg, Kristian; Niu, Jingbo; Weir, Adam; Tol, Johannes L.; Guermazi, Ali (European Radiology, 2017)
To describe a multi-dimensional MRI assessment approach with a focus on acute musculotendinous groin lesions, and to evaluate scoring reproducibility.Male athletes who participated in competitive sports and presented within 7 days of an acute onset of sports-related groin pain were included. All athletes underwent MRI (1.5 T) according to a standardized groin-centred protocol. From several calibration sessions, a system was developed assessing grade, location and extent of muscle strains, peri-lesional haematoma, as well as other non-acute findings commonly associated with long-standing groin pain. Kappa (K) statistics and intraclass correlation coefficients (ICCs) were used to describe intra- and inter-rater reproducibility.Seventy-five athletes (mean age 26.6 ± 4.4 years) were included in the analyses, and 85 different acute lesions were observed. Adductor longus lesions were most common (42.7 %) followed by rectus femoris lesions (16.3 %). Kappa values ranged between 0.70 and 1.00 for almost all categorical features for acute lesions, with almost perfect intra- and inter-rater agreement (K = 0.89-1.00) for presence, number, location and grading of lesions. ICCs ranged between 0.77 and 1.00 for continuous measures of acute lesion extent.A standardized MRI assessment approach of acute groin injuries was described and showed good intra- and inter-rater reproducibility.o A multidimensional MRI assessment approach for acute groin injuries was described. o Standardized MRI assessment of acute musculotendinous groin injuries has high reproducibility. o Injury location and injury extent can be scored reliably using 1.5 T MRI.
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Reliability of semiquantitative assessment of osteophytes and subchondral cysts on tomosynthesis images by radiologists with different levels of expertise - Hayashi, Daichi; Xu, Li; Gusenburg, Jeffrey; Roemer, Frank; Hunter, David J.; Li, Ling; Guermazi, Ali (Diagnostic and Interventional Radiology, 2014)
We aimed to assess reliability of the evaluation of osteophytes and subchondral cysts on tomosynthesis images when read by radiologists with different levels of expertise.Forty subjects aged >40 years had both knees evaluated using tomosynthesis. Images were read by an "experienced" reader (musculoskeletal radiologist with prior experience) and an "inexperienced" reader (radiology resident with no prior experience). Readers graded osteophytes from 0 to 3 and noted the presence/absence of subchondral cysts in four locations of the tibiofemoral joint. Twenty knees were randomly selected and re-read. Inter- and intrareader reliabilities were calculated using overall exact percent agreement and weighted ? statistics. Diagnostic performance of the two readers was compared against magnetic resonance imaging readings by an expert reader (professor of musculoskeletal radiology).The experienced reader showed substantial intrareader reliability for graded reading of osteophytes (90%, ?=0.93), osteophyte detection (95%, ?=0.86) and cyst detection (95%, ?=0.83). The inexperienced reader showed perfect intrareader reliability for cyst detection (100%, ?=1.00) but intrareader reliability for graded reading (75%, ?=0.79) and detection (80%, ?=0.61) of osteophytes was lower than the experienced reader. Inter-reader reliability was 61% (?=0.72) for graded osteophyte reading, 91% (?=0.82) for osteophyte detection, and 88% (?=0.66) for cyst detection. Diagnostic performance of the experienced reader was higher than the inexperienced reader regarding osteophyte detection (sensitivity range 0.74-0.95 vs. 0.54-0.75 for all locations) but diagnostic performance was similar for subchondral cysts.Tomosynthesis offers excellent intrareader reliability regardless of the reader experience, but experience is important for detection of osteophytes.
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Renal denervation in moderate treatment-resistant hypertension - Ott, Christian; Mahfoud, Felix; Schmid, Axel; Ditting, Tilmann; Sobotka, Paul A.; Veelken, Roland; Spies, Aline; Ukena, Christian; Laufs, Ulrich; Uder, Michael; Boehm, Michael; Schmieder, Roland (Journal of the American College of Cardiology, 2013)
Objectives This study sought to investigate the effect of renal denervation (RDN) in patients with treatment-resistant hypertension according to the established definition (Joint National Committee VII and European Society of Hypertension/European Society of Cardiology guidelines), that is, office blood pressure (BP) ≥140/90 mm Hg (with at least three antihypertensive drugs, including a diuretic, in adequate doses) and confirmed by 24-h ambulatory BP monitoring (ABPM). Background RDN emerged as an innovative interventional antihypertensive therapy. However, so far, only patients with severe hypertension (systolic BP ≥160 mm Hg or ≥150 mm Hg for patients with type 2 diabetes) have been investigated. Methods In this study, there were 54 patients with moderate treatment-resistant hypertension (office BP ≥140/90 mm Hg and <160/100 mm Hg and diagnosis confirmed by 24-h ABPM of ≥130/80 mm Hg) who underwent catheter-based RDN using the Symplicity catheter (Medtronic Inc., Mountain View, California). Results Patients were treated with 5.1 ± 1.4 antihypertensive drugs on average. Office BP was significantly reduced by 13/7 mm Hg 6 months after RDN (systolic: 151 ± 6 mm Hg vs. 138 ± 21 mm Hg, p < 0.001; diastolic: 83 ± 11 mm Hg vs. 75 ± 11 mm Hg, p < 0.001). In patients (n = 36) who underwent ABPM 6 months after treatment, there was a reduction in average 24-h ABPM by 14/7 mm Hg (systolic: 150 ± 16 mm Hg vs. 136 ± 16 mm Hg, p < 0.001; diastolic: 83 ± 10 mm Hg vs. 76 ± 10 mm Hg, p < 0.001). In 51% of patients, office BP was controlled below 140/90 mm Hg after RDN. In addition, heart rate decreased from 67 ± 11 to 63 ± 10 beats/min (p = 0.006). Conclusions Our data indicate that RDN may reduce office and 24-h ambulatory BP substantially in patients with moderate treatment-resistant hypertension. (Renal Denervation in Treatment Resistant Hypertension; NCT01687725). © 2013 by the American College of Cardiology Foundation.
CRIS-Team Scopus Importer:2023-03-08
Keywords: 24-h ambulatory blood pressure; renal denervation; treatment-resistant hypertension

Renal denervation in refractory hypertension: joint statement of the German hypertension league DHL eV and the German societies of cardiology, angiology, nephrology and radiology - Vonend, Oliver; Boehm, Michael; Eckert, Siegfried; Hausberg, Martin; Rittger, Harald; Rump, Lars-Christian; Schmieder, Roland; Schulte, Karl-Ludwig; Schunkert, Heribert; Uder, Michael; Veelken, Roland; Vorwerk, Dierk; et al. (Deutsche Medizinische Wochenschrift, 2015)
Arterial hypertension is a major risk factor for cardiovascular mortality and remains insufficiently controlled in Germany. The sham controlled Symplicity HTN-3 trial did meet its primary safety endpoint but failed to meet its primary efficacy endpoint. Renal denervation can not replace established, well-proven therapies. It can only be used in selected truly resistant hypertensive patients as an additive approach and should be performed by specialized centers only. Randomized controlled trials are needed to further evaluate renal denervation.
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Renal denervation preserves renal function in patients with chronic kidney disease and resistant hypertension - Ott, Christian; Mahfoud, Felix; Schmid, Axel; Toennes, Stefan W.; Ewen, Sebastian; Ditting, Tilmann; Veelken, Roland; Ukena, Christian; Uder, Michael; Boehm, Michael; Schmieder, Roland (Journal of Hypertension, 2015)
Arterial hypertension and increased sympathetic activity are underlying pathogenetic mechanisms of the progressive loss of renal function in patients with chronic kidney disease (CKD). Meta-analyses have shown that impaired renal function is an independent cardiovascular risk factor. We hypothesized that renal denervation (RDN) decreases the decline of renal function in patients with CKD stages 3 and 4 and treatment-resistant hypertension.We performed an observational study of 27 patients with CKD stages 3 and 4, office blood pressure (BP) >= 140/90 mmHg, while on at least three antihypertensive drug classes including diuretic, and diagnosis confirmed by 24-h ambulatory BP measurement >= 130/80 mmHg. All patients underwent catheter-based RDN using the Symplicity Flex RDN System (Medtronic Inc., Santa Rosa, California, USA). Renal function was evaluated for up to 3 years prior and 1 year after RDN. The change in estimated glomerular filtration rate (eGFR) was calculated by regression slope individually for each patient before and after RDN. The study was registered at http://www.clinicaltrials.gov (ID: NCT01442883).Mean baseline BP was 156 ± 12/82 ± 13 mmHg, despite treatment with 6.2 ± 1.1 antihypertensive drugs. One year after RDN, office BP was reduced by 20 ± 20 (P < 0.001)/8 ± 14 mmHg (P = 0.005) and average 24-h ambulatory BP by 9 ± 14 (P = 0.009)/4 ± 7 mmHg (P = 0.019). Before RDN, eGFR declined by -4.8 ± 3.8 ml/min per 1.73 m per year, and after RDN eGFR improved by +1.5 ± 10 ml/min per 1.73 m at 12 months (P = 0.009).Our observational pilot study in patients with CKD stages 3 and 4 indicates that treatment of hypertension with RDN decreases BP and slows or even halts the decline of renal function.
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Renal fibrosis is the common feature of autosomal dominant tubulointerstitial kidney diseases caused by mutations in mucin 1 or uromodulin - Ekici, Arif Bülent; Hackenbeck, Thomas; Moriniere, Vincent; Panness, Andrea; Büttner, Maike; Uebe, Steffen; Janka, Rolf Matthias; Wiesener, Antje; Hermann, Ingo; Grupp, Sina; Hornberger, Martin; Huber, Tobias B.; et al. (Kidney International, 2014)
For decades, ill-defined autosomal dominant renal diseases have been reported, which originate from tubular cells and lead to tubular atrophy and interstitial fibrosis. These diseases are clinically indistinguishable, but caused by mutations in at least four different genes: UMOD, HNF1B, REN, and, as recently described, MUC1. Affected family members show renal fibrosis in the biopsy and gradually declining renal function, with renal failure usually occurring between the third and sixth decade of life. Here we describe 10 families and define eligibility criteria to consider this type of inherited disease, as well as propose a practicable approach for diagnosis. In contrast to what the frequently used term 'Medullary Cystic Kidney Disease' implies, development of (medullary) cysts is neither an early nor a typical feature, as determined by MRI. In addition to Sanger and gene panel sequencing of the four genes, we established SNaPshot minisequencing for the predescribed cytosine duplication within a distinct repeat region of MUC1 causing a frameshift. A mutation was found in 7 of 9 families (3 in UMOD and 4 in MUC1), with one indeterminate (UMOD p.T62P). On the basis of clinical and pathological characteristics we propose the term 'Autosomal Dominant Tubulointerstitial Kidney Disease' as an improved terminology. This should enhance recognition and correct diagnosis of affected individuals, facilitate genetic counseling, and stimulate research into the underlying pathophysiology.
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RENAL HEMODYNAMIC CHANGES AFTER RENAL DENERVATION - Schmieder, R. S.; Schmid, Axel; Janka, Rolf Matthias; Ditting, T.; Veelken, Roland; Uder, Michael; Schmieder, Roland; Ott, Christian (2016)
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Repeatability of Dixon magnetic resonance imaging and magnetic resonance spectroscopy for quantitative muscle fat assessments in the thigh - Grimm, Alexandra; Meyer, Heiko; Nickel, Marcel D.; Nittka, Mathias; Raithel, Esther; Chaudry, Oliver; Friedberger, Andreas; Uder, Michael; Kemmler, Wolfgang; Engelke, Klaus; Quick, Harald H. (Journal of Cachexia, Sarcopenia and Muscle, 2018)
BACKGROUND: Changes in muscle fat composition as for example observed in sarcopenia or muscular dystrophy affect physical performance and muscular function, like strength and power. The purpose of the present study is to measure the repeatability of Dixon magnetic resonance imaging (MRI) for assessing muscle volume and fat in the thigh. Furthermore, repeatability of magnetic resonance spectroscopy (MRS) for assessing muscle fat is determined. METHODS: A prototype 6-point Dixon MRI method was used to measure muscle volume and muscle proton density fat fraction (PDFF) in the left thigh. PDFF was measured in musculus semitendinosus of the left thigh with a T2-corrected multi-echo MRS method. For the determination of short-term repeatability (consecutive examinations), the root mean square coefficients of variation of Dixon MRI and MRS data of 23 young and healthy (29 ± 5 years) and 24 elderly men with sarcopenia (78 ± 5 years) were calculated. For the estimation of the long-term repeatability (13 weeks between examinations), the root mean square coefficients of variation of MRI data of seven young and healthy (31 ± 7 years) and 23 elderly sarcopenic men (76 ± 5 years) were calculated. Long-term repeatability of MRS was not determined. RESULTS: Short-term errors of Dixon MRI volume measurement were between 1.2% and 1.5%, between 2.1% and 1.6% for Dixon MRI PDFF measurement, and between 9.0% and 15.3% for MRS. Because of the high short-term repeatability errors of MRS, long-term errors were not determined. Long-term errors of MRI volume measurement were between 1.9% and 4.0% and of Dixon MRI PDFF measurement between 2.1% and 4.2%. CONCLUSIONS: The high degree of repeatability of volume and PDFF Dixon MRI supports its use to predict future mobility impairment and measures the success of therapeutic interventions, for example, in sarcopenia in aging populations and muscular dystrophy. Because of possible inhomogeneity of fat infiltration in muscle tissue, the application of MRS for PDFF measurements in muscle is more problematic because this may result in high repeatability errors. In addition, the tissue composition within the MRS voxel may not be representative for the whole muscle.
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Repeating of local therapy of distant metastases increases overall survival in patients with synchronous metastasized rectal cancer-a monocentric analysis - Haderlein, Marlen; Lettmaier, Sebastian; Langheinrich, Melanie; Schmid, Axel; Semrau, Sabine; Hecht, Markus; Beck, Michael; Schmidt, Daniela; Grützmann, Robert; Fietkau, Rainer; Denz, Axel (International Journal of Colorectal Disease, 2018)
PURPOSE: The aim was to evaluate the outcome of treatment-naive patients with synchronous metastatic rectal cancer after chemotherapy with FOLFOXIRI followed by local therapeutic procedures of all tumor lesions as complete as possible. METHODS: We reviewed data of 30 patients with synchronous distant metastatic rectal cancer who underwent chemotherapy with FOLFOXIRI and subsequent local therapy in our institution. RESULTS: Median follow-up was 28 months (range: 8; 74). Cumulative overall survival (OS) and progression-free survival (PFS) was 93.3, 76.9, 55.6% and 46.2, 29.7, 29.7% after 1, 2, 4 years. Non-response to chemotherapy with FOLFOXIRI was associated with a highly significant decreased OS (p < 0.0001). The consistent use of local ablative procedures led to a statistically significant increase in OS (p < 0.0001), but not in PFS (p = 0.635). Patients with ≤ 4 distant metastases showed a better OS (p = 0.033). CONCLUSIONS: Response to intensified first-line chemotherapy with FOLFOXIRI, treatment of the primary rectal tumor, and repeated thorough local ablative procedures in patients with synchronous metastasized rectal cancer may lead to long-term survival, even in a subset of patients with unresectable disease at initial diagnosis.
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Reply to the letter: Long term use of analgesics and risk of osteoarthritis progressions and knee replacement - Hafezi-Nejad, N.; Guermazi, A.; Roemer, Frank; Eng, J.; Zikria, B.; Demehri, S. (Osteoarthritis and Cartilage, 2017)
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Reproducibility of aortic annulus measurements by computed tomography - Schuhbaeck, Annika; Achenbach, Stephan; Pflederer, Tobias; Schmid, Julia; Nef, Holger; Rixe, Johannes; Hecker, Franziska; Schneider, Christian; Lell, Michael; Uder, Michael; Arnold, Martin; Marwan, Mohamed (European Radiology, 2014)
To evaluate a systematic approach for measurement of aortic annulus dimensions by cardiac computed tomography.CT data sets of 64 patients were evaluated. An oblique cross-section aligned with the aortic root was created by systematically identifying the caudal insertion points of the three aortic cusps and sequentially aligning them in a double oblique plane. Aortic annulus dimensions, distances of coronary ostia and a suitable fluoroscopic projection angle were independently determined by two observers.Interobserver intraclass correlation coefficients (ICC) for aortic annulus diameters were excellent (ICC 0.89-0.93). Agreement for prosthesis size selection was excellent (? = 0.86 for mean, ? = 0.84 for area-derived and ? = 0.91 for circumference-derived diameter). Mean distances of the left/right coronary ostium were 13.4 ± 2.4/14.4 ± 2.8 mm for observer 1 and 13.2 ± 2.7/13.5 ± 3.2 mm for observer 2 (p = 0.30 and p = 0.0001, respectively; ICC 0.76/0.77 for left/right coronary artery). A difference of less than 10° for fluoroscopic projection angle was achieved in 84.3% of patients.A systematic approach to generate a double oblique imaging plane exactly aligned with the aortic annulus demonstrates high interobserver and intraobserver agreements for derived measurements which are not influenced by aortic root calcification.o Systematic approach to generate a double oblique imaging plane for TAVI evaluation. o This method is straightforward and software independent. o An approach with high reproducibility, not influenced by aortic root calcification.
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Reproducibility of CMRO2 determination using dynamic 17 O MRI - Niesporek, Sebastian C.; Umathum, Reiner; Lommen, Jonathan M.; Behl, Nicolas G. R.; Paech, Daniel; Bachert, Peter; Ladd, Mark E.; Nagel, Armin Michael (Magnetic Resonance in Medicine, 2018)
PURPOSE: To assess the reproducibility of 17 O MRI-based determination of the cerebral metabolic rate of oxygen consumption (CMRO2 ) in healthy volunteers. To assess the influence of image acquisition and reconstruction parameters on dynamic quantification of functional parameters such as CMRO2 . METHODS: Dynamic 17 O MRI data were simulated and used to investigate influences of temporal resolution (Δt) and partial volume correction (PVC) on the determination of CMRO2 . Three healthy volunteers were examined in two separate examinations. In vivo 17 O MRI measurements were conducted with a nominal spatial resolution of (7.5 mm)3 using a density-adapted radial sequence with golden angle acquisition scheme. In each measurement, 4.0 ± 0.1 L of 70%-enriched 17 O gas were administered using a rebreathing system. Data were corrected with a PVC algorithm, and CMRO2 was determined in gray matter (GM) and white matter (WM) compartments using a three-phase metabolic model (baseline, 17 O inhalation, decay phase). RESULTS: Comparison with the ground truth of simulations revealed improved CMRO2 determination after application of PVC and with Δt ≤ 2:00 min. Evaluation of in vivo data yields to CMRO2,GM = 2.31 ± 0.1 μmol/g/min and to CMRO2,WM = 0.69 ± 0.04 μmol/g/min with coefficients of variation (CoV) of 0.3-5.5% and 4.3-5.0% for intra-volunteer and inter-volunteer data, respectively. CONCLUSION: This in vivo 17 O inhalation study demonstrated that the proposed experimental setup enables reproducible determination of CMRO2 in healthy volunteers. Magn Reson Med 79:2923-2934, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
EVALuna2:36250

Reproducibility of Kidney Perfusion Measurements With Arterial Spin Labeling at 1.5 Tesla MRI Combined With Semiautomatic Segmentation for Differential Cortical and Medullary Assessment - Hammon, Matthias; Janka, Rolf Matthias; Siegl, Christian; Seuß, Hannes; Grosso, Roberto; Martirosian, Petros; Schmieder, Roland; Uder, Michael; Kistner, Iris (Medicine, 2016)
Magnetic resonance imaging with arterial spin labeling (ASL) is a noninvasive approach to measure organ perfusion. The purpose of this study was to evaluate the reproducibility of ASL kidney perfusion measurements with semiautomatic segmentation, which allows separate quantification of cortical and medullary perfusion.The right kidneys of 14 healthy volunteers were examined 6 times on 2 occasions (3 times at each occasion). There was a 10-minute pause between each examination and a 14-day interval between the 2 occasions. Cortical, medullary, and whole kidney parenchymal perfusion was determined with customized semiautomatic segmentation software. Coefficient of variances (CVs) and intraclass correlations (ICCs) were calculated.Mean whole, cortical, and medullary kidney perfusion was 307.26 ± 25.65, 337.10 ± 34.83, and 279.61 ± 26.73 mL/min/100 g, respectively. On session 1, mean perfusion for the whole kidney, cortex, and medulla was 307.08 ± 26.91, 336.79 ± 36.54, and 279.60 ± 27.81 mL/min/100 g, respectively, and on session 2, 307.45 ± 24.65, 337.41 ± 33.48, and 279.61 ± 25.94 mL/min/100 g, respectively (P > 0.05; R = 0.60/0.59/0.54). For whole, cortical, and medullary kidney perfusion, the total ICC/CV were 0.97/3.43 ± 0.86%, 0.97/4.19 ± 1.33%, and 0.96/4.12 ± 1.36%, respectively. Measurements did not differ significantly and showed a very good correlation (P > 0.05; R = 0.75/0.76/0.65).ASL kidney measurements combined with operator-independent semiautomatic segmentation revealed high correlation and low variance of cortical, medullary, and whole kidney perfusion.
EVALuna2:3854

Rescue therapy of antisynthetase syndrome with CD19-targeted CAR-T cells after failure of several B-cell depleting antibodies - Taubmann, Jule; Knitza, Johannes; Müller, Fabian; Völkl, Simon; Aigner, Michael; Kleyer, Arnd; Gary, Regina; Kretschmann, Sascha; Böltz, Sebastian; Atzinger, Armin; Kuwert, Torsten; Roemer, Frank; et al. (Rheumatology, 2024)
EVALuna2:539551

Research in radiology - Semelka, Richard C.; Brand, Michael; Uder, Michael; Kuefner, Michael A.; Stonestreet, John; Elias, Jorge (Wiley Blackwell, 2013)
CRIS-Team Scopus Importer:2023-03-08

Resection of dominant fusiform gyrus is associated with decline of naming function when temporal lobe epilepsy manifests after the age of five: A voxel-based lesion-symptom mapping study - Reindl, Caroline; Allgäuer, Andrea; Kleiser, Benedict; Onugoren, Müjgan Dogan; Lang, Johannes; Welte, Tamara; Stritzelberger, Jenny; Winder, Klemens; Schwarz, Michael; Gollwitzer, Stephanie; Trollmann, Regina; Rösch, Julie; et al. (NeuroImage: Clinical, 2022)
Objective: To determine patients’ characteristics and regions in the temporal lobe where resections lead to a decline in picture naming. Methods: 311 patients with left hemispheric dominance for language were included who underwent epilepsy surgery at the Epilepsy Center of Erlangen and whose picture naming scores (Boston Naming Test, BNT) were available preoperatively and 6-months postoperatively. Surgical lesions were mapped to an averaged template based on preoperative and postoperative MRI using voxel-based lesion-symptom mapping (VBLSM). Postoperative brain shifts were corrected. The relationship between lesioned brain areas and the presence of a postoperative naming decline was examined voxel-wise while controlling for effects of overall lesion size at first in the total cohort and then restricted to temporal lobe resections. Results: In VBLSM in the total sample, a decline in BNT score was significantly related to left temporal surgery. When only considering patients with left temporal lobe resections (n = 121), 40 (33.1%) significantly worsened in BNT postoperatively. VBLSM including all patients with left temporal resections generated no significant results within the temporal lobe. However, naming decline of patients with epilepsy onset after 5 years of age was significantly associated with resections in the left inferior temporal (extent of BNT decline range: 10.8− 14.4%) and fusiform gyrus (decline range: 12.1−18.4%). Significance: Resections in the posterior part of the dominant fusiform and inferior temporal gyrus was associated with a risk of deterioration in naming performance at six months after surgery in patients with epilepsy onset after 5 years of age but not with earlier epilepsy onset.
CRIS-Team Scopus Importer:2022-08-19
Keywords: Basal temporal language area; Epilepsy surgery; Gyrus fusiformis; Lesion localization; Naming; Neuropsychological outcome

Resolution of vascular inflammation in patients with new-onset giant cell arteritis: data from the RIGA study - Schönau, Verena; Roth, Jessica; Tascilar, Koray; Corte, Giulia; Manger, Bernhard; Rech, Jürgen; Schmidt, Daniela; Cavallaro, Alexander Josef; Uder, Michael; Crescentini, Filippo; Boiardi, Luigi; Casali, Massimiliano; et al. (Rheumatology, 2021)
OBJECTIVES: Efficacy evaluation of GCA treatment is primarily based on non-specific symptoms and laboratory markers. We aimed to assess the change in vascular inflammation in patients with large vessel (LV)-GCA under different treatments using [18F]FDG PET/CT. METHODS: Observational study on patients with new-onset, active LV-GCA starting treatment with either prednisolone monotherapy (PRED) or combination with MTX or tocilizumab (TOC). All patients underwent baseline and follow-up PET/CT. The aorta and its major branches were assessed using PET vascular activity score (PETVAS) by independent readers. Cumulative glucocorticoid doses and cessation of glucocorticoid treatment were documented in all patients. RESULTS: We included 88 LV-GCA patients, 27 were treated with PRED, 42 with MTX and 19 with TOC. PETVAS decreased from 18.9-8.0 units at follow-up in the overall population (P <0.001). PETVAS changes were numerically higher in patients receiving MTX (-12.3 units) or TOC (-11.7 units) compared with PRED (-8.7). Mean cumulative prednisolone dosages were 5637, 4418 and 2984 mg in patients treated with PRED, MTX and TOC (P =0.002). Risk ratios for glucocorticoid discontinuation at the time of follow-up PET/CT were 6.77 (95% CI: 1.01, 45.29; P =0.049) and 16.25 (95% CI: 2.60, 101.73; P =0.003) for MTX and TOC users compared with PRED users. CONCLUSION: Treatment of LV-GCA inhibits vascular inflammation in the aorta and its major branches. While similar control of vascular inflammation was achieved with PRED, MTX and TOC treatments, TOC showed a strong glucocorticoid sparing effect, supporting the concept of initial combination therapy.
CRIS-Team Scopus Importer:2021-09-24
Keywords: 18F-fluorodeoxyglucose positron emission tomography/computed tomography; giant cell arteritis; glucocorticoids; large vessel vasculitis; methotrexate; tocilizumab; treatment